PMU Sign - Form

Client's Name

Please check each statement below to acknowledge that you have read and understand them before signing.

I understand that several treatments may be needed in order to attempt to achieve my desired results. However, I have not received any guarantees to the quality of the outcome of the process.

I understand there are medical options available for pigment (tattoo) removal. I have decided to decline those methods.

I understand that the unwanted pigment may not be successfully lightened to the point that it can no longer be seen. Scarring as hyper-pigmentation or hypo-pigmentation, or other damage to the skin may occur during this process and may be permanent. This is rare but it can happen. I will not hold my technician, Elicia Soltesz, and/or the distributor/manufacturer of tattoo removal products used in this attempted pigment (tattoo) lightening or removal liable for any damages that may occur to my person.

I understand there will be no refunds if the desired lightening result is not achieved.

I understand that lightening tattoo pigment is difficult, if even possible. As a result I will not hold my technician, Elicia Soltesz responsible for any resultant failure to lighten the unwanted pigment.

I agree to submit to before and after photographs, and give my permission to use such photographs for publication and/or teaching purposes.

I agree to follow all aftercare instructions provided to me by my technician.

I have been duly informed of the natures, risks, possible complications and consequences as listed above. I further understand that my technician is not a medical doctor

There is a fee for this service and additional fees for all additional sessions. The fee’s have been explained to me and I agree to the fees.

I have disclosed all that has been asked of me to the best of my ability and I understand all information listed above. I have had all my questions answered, and agree to all conditions and provisions of this document as evidenced by signature below. I accept the risks for having this procedure done therefore release my technician, Elicia Soltesz, from any and all liability.

I understand that it is very normal for my brows to be extremely red immediately after the procedure and for many days following and throughout the entire healing process.

Which of the following best describes your skin type?

I. Always burns, never tans

II. Usually burns, sometimes tans

III. Sometimes burns, always tans

IV. Rarely burns, always tans

V. Brown, moderately pigmented skin

VI. Black skin

For skin types V and VI; I understand that I am at a higher risk for hyper-pigmentation and hypo-pigmentation than other skin types. I agree to the risk involved.

I give Elicia Soltesz permission to use any relevant photos taken for her portfolio and also for advertising online on her website and social media accounts.

Yes, any and all relevant pictures and/or videos - full face included.

Yes, but ONLY close up, non-personally identifying pictures and/or videos.

No, I do not want any photographs and/or videos of me used for advertising purposes.

Print Name