Permanent Makeup Saline Removal Intake Form
**This form only needs to be filled out once every TWO years unless your information has changed** 
If you have any questions please email us at Arch.Angel.BrowsStudio@gmail.com
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Full Name *
Date Of Birth *
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Email *
Address *
Phone number *
Where Did You Hear About Us? *
Please Read Carefully And Answer Each Section
Please send in a photo of the PMU or tattoo you would like removed for approval before confirming your appointment.
Email us a photo at Arch.Angel.BrowStudio@gmail.com OR Text us a photo at (704) 765-2225
(Optional) Please List Out Your Skincare Routine
Do you have any medical conditions or take any medications that may affect bleeding or healing? For example; antibiotics, steroids, blood thinners ,accutane, immunosuppressants, etc.
If yes, please explain in "Other" text box below.
 *
Have you received chemotherapy or radiation within the past six months? *
Check any of the following allergies that apply
Check any of the following conditions that apply. (Items with *** are contradictions to permanent makeup)
PLEASE READ OVER THE FOLLOWING STATEMENTS CAREFULLY:
  • Permanent cosmetics or Removal cannot be performed on pregnant women or nursing mothers.
  • Permanent cosmetics or Removal cannot be applied to any person under the age of 18.
  • There is no way to advise on how many tattoo removal sessions you will need.
  • Infections can occur if after instructions are not followed correctly.
  • There may be swelling and redness following the procedure.You may experience minor bleeding during procedure.
  • Scarring is extremely rare, but may occur.
  • The pigments will fade, depending upon your skin cycle.
  • After your session, your treated area may appear darker then faded over the healing time.
  • You must wait a minimum of 8 weeks after removal before having your next removal session or pmu session.
IMPORTANT PRECARE AND AFTERCARE INFO:

•Aftercare instructions will be verbally explained and a written copy will be given to take home with you at the time of your appointment. You will also receive everything you need in your kit. 

Precare:

  • Please be sure to bring in a valid ID to your appointment 
  • Do not use anti-aging or anti-acne skincare (Especially Retin-A) 2 weeks prior to your appointment
  • Avoid tanning or excess sun exposure at least 72 hours before your appointment
  • Avoid chemical peels and lasers on brow area 6 weeks before your appointment
  • Do not tint or laminate brows within 2 weeks of your appointment 
  • You are welcome to bring headphones or a blanket if it makes you more comfortable. As a tattoo studio, we are unable to provide blankets.

For a full list of pre care instructions, please visit my website- Pre-Care and After-Care

 

Aftercare:

Days 1-7: 

-Cleanse area by washing face as usual with a gentle cleanser 1-2 times a day

-Blot area with Saline Wound Wash (provided) at least 3-4+ times a day 

-Avoid heavy sweating, direct sunlight, picking or scratching area and minimize water on area until scabs have fallen off naturally


After healing (Typically 7-14 days) 

- Use Vitamin E Oil (provided) on area to help renew skin after removal

Consent Statements - Please read over each statement carefully and check each box to confirm. You MUST confirm each statement to be eligible for Permanent Makeup
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Required
Please Sign Your Name Below After Reading And Checking Off Each Statement Above *
Date *
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I certify that I have read and fully understand the above consent and procedure permit; that the explanations therein referred to were made and accept full responsibility for these and or other complications, which may arise or result during or following the PMU procedure. The treatment is performed at my request according to this consent, pre-procedure form and post-procedure guidelines. All services rendered at Arch Angel Cosmetic Tattoo are NON-REFUNDABLE. I hereby authorize Arch Angel Cosmetic Tattoo Technician, Michaela Smith, to perform PMU procedure on me.

Please Sign Your Name Below to Agree to This Statement
 *
MEDIA RELEASE CONSENT: For the purpose of documentation, insurance, advertising, record and use in portfolio, I CONSENT to the taking of "before" and "after" photographs of my procedure.

Please sign your name below to agree to this statement:
 *
Please read the following statement carefully regarding healing process.

The healing process requires commitment from the client to follow healing protocols and stay away from regiments that could interfere with obtaining the desired appearance.

  • I understand that to achieve the best result I must be willing to follow the healing guidelines given to me 
  • I understand that I may, experience scabbing, flaking, and changes in color during the healing time. This is the normal part of the healing process and I should not try to pick scabs or cover up with personal regiment.
  • I understand that pigment is not removed immediately during the removal service, but instead the pigment will leave the skin through the scabbing during healing
  • I understand that applying makeup to treated area will cause the healed result to be less than desirable
  • I understand that if I decide to have a facial, laser treatment or any other spa related services immediately after or during healing the process that the results may not be best.
Please Sign Your Name Below After Reading The Statement Above: *
Date
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OPTIONAL Customize Client Experience
What would you like to listen to during your appointment? (Optional)
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What essential oil scent would you prefer in the diffuser? You may choose more than one. (Optional)
Any notes you would like to leave for your artist? (Optional)
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