Client Health & Liability Waiver - PMU
NOTE: Please be sure to avoid all blood thinners and anticoagulants, such as ASPIRIN, ALCOHOL, FISH OIL/OMEGA-3S, SMOKING, etc. and limit caffeine, for ONE to TWO DAYS before your session.
These things can have a negative effect on results, healing and retention!
***This is not medical advice, just a warning about potential contraindications. Please consult your doctor before skipping any medications you are prescribed to take to confirm whether it is safe to do so.***

For anyone who menstruates, it is common to experience increased overall sensitivity or reduced pain tolerance during menstruation, so keep this in mind if you wish to plan around that when scheduling services.
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Email *
Full Name *
Preferred Name/Nickname
Phone Number *
How did you hear about us? *
Mailing Address
Date of Birth *
MM
/
DD
/
YYYY
Social Media Name/Handle 
Occupation *
Emergency Contact Name and Phone Number
 *
Emergency Contact Relationship *
Skin Type (Fitzpatrick scale, Reaction to Sun) *
Ethnic Background *
Procedure(s) Desired *
Required
Have you had any vaccines or immunizations within the last two weeks? *
(Vaccinations/Immunizations can cause increased inflammatory responses so it is recommended to wait at least two weeks before or after receiving permanent makeup, tattoos or other such services.)
Please list all medications you currently take and what they are prescribed to treat:
(If none, put "none") *
Please list all medications you used to take, but have recently stopped taking (within the last 6 months) and what they were prescribed to treat: 
(If none, put "none") *
Do use Accutane? / Did you stop Accutane less than a year ago? *
Have you been prescribed a steroid within the last 6 months?  *
Do you use Retinols (like Retin-A) or have you within the last 6 months? *
Do you get chemical or laser peels? *
Do you use tanning beds or sunbathe? *
Any surgeries within the last year? If not, put "none"; if so, please describe (procedure & date): *
If under the care of a medical provider, please give doctor's name and contact (phone or location)
Have you received chemotherapy or radiation treatment within the last year? *
Do you numb easily? (For example with dental injections) *
Are you currently pregnant or breastfeeding? *
Do you have an MRI scheduled in the next 3 months? *
Please list any allergies (especially to supplements, foods, dyes, medications, metals, product ingredients and other materials): *
General Health Screen: Please mark all that apply to you *
Required
If you selected Other Autoimmune or any Dermatological Condition, please briefly describe:
If you are interested in Eyeliner / Lash Line Enhancement, please mark all that apply to you below, or if none, select None of the Above.
(If not interested in Eyeliner, please mark Not Applicable.)
 *
Required
If interested in Lip Blush, please mark all that apply to you below, or if none, select None of the Above.
(If not interested in Lip Blush, please mark Not Applicable.)
 *
Required
Have you ever had Aesthetic/Cosmetic Surgery? If so, please note date(s), procedure(s):
(If not, put "no") *
Have you had Botox or other cosmetic injections (Juvederm, Dysport, etc), or do you plan to in the near future? Please describe:
(Or put "no" if not) *
Do you scar in a raised manner? *
Do scars heal darker than the rest of your skin? *
Have you had any permanent makeup/microblading/tattoos before? If so, please list:
(If not, put "no") *
Any history of sensitivity/reaction to any particular tattoo pigment/ink colors?
Permanent Makeup heals differently based on skin types and lifestyles, and it is important either way to complete a touch up within the required time frame (6-8 weeks) to achieve desired results (not included in initial session price). *
Required
I agree to partake in this service, and understand the inherent risk of exposure to Covid-19 or other pathogens in public spaces, despite strict sanitation and disinfection protocols in line with CDC and Health Department requirements and guidelines, and agree not to hold Tiger Lily Collective LLC or its representatives responsible should exposure occur. *
Required
I understand that permanent makeup and scar camouflage are forms of tattoo, and that one must be at least 18 years old to receive a tattoo in the state of Wisconsin. I have truthfully represented that I am at least 18 years of age, and confirm that obtaining a tattoo is my choice alone. *
Required
I agree to release and hold harmless Tiger Lily Collective LLC and its representatives from any damages, claims or legal actions arising from or in any way connected to the tattoo or other services rendered. *
Required
I acknowledge that infection is a possible result of obtaining a tattoo, particularly in the event that proper aftercare is not followed. I agree to take care of my tattoo to the best of my ability and strictly adhere to the aftercare instructions provided.  *
Required
I give consent to Tiger Lily Collective LLC to use any photos, videos, and any other likeness of me taken by them or made on their behalf, to be used for portfolio and marketing purposes. *
Required
I acknowledge that by typing my full name below, this is considered a legal and binding document, and I agree to the terms and have honestly answered the items described in this form: *
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