Health History Form

First Name *

Last Name *

Email *

Phone Number *

Do you smoke? *

Yes

No

Have you had any micro-pigmentation procedure before? *

Yes

No

Which area and how long ago? *

Do you consume alcohol frequently? *

Yes

No

Have you received the pre/post-procedure care instructions? *

Yes

No

Do you agree to proceed with the procedure after all explanations were provided? *

Yes

No

Are you aware that there may be color variation and a need for touch-up? *

Yes

No

I understand that micropigmentation is a form of cosmetic tattooing, and that the results may vary depending on skin type, lifestyle, and aftercare.

I understand that the treated area may become red, swollen, or tender for several days following the procedure.

I am aware that slight unevenness, color changes, or fading can occur, and that a touch-up session may be necessary.

I understand that scabbing, flaking, or itching may occur during healing. Picking or scratching the area may cause pigment loss or scarring.

I acknowledge that some pigment may not retain properly due to oily skin, certain medications, health conditions, or previous procedures.

I understand that infection, allergic reactions, or skin irritation are rare but possible, and I must follow the aftercare instructions to minimize risks.

I have informed the artist of any medical conditions, allergies, or current medications I am taking that may affect the outcome of the procedure.

I understand that the color may appear darker immediately after the procedure and will lighten during the healing process.

I acknowledge that lips are more sensitive and prone to swelling and that cold sores may be triggered even if I have never had one before.

I agree to contact a medical professional if I experience signs of infection such as excessive redness, swelling, pus, or fever.

I declare that the information provided is true and I am aware of the risks, necessary care, and expected results of the procedure.

Book Now