Microblading Consultation and Consent Form
Under Wis. Admin. Code § SPS 221.10(1)(a), a tattooist may not tattoo a patron without first obtaining the signed, informed consent of the person on a form approved by the Department of Safety and Professional Services (Department).
The Department of Safety and Professional Services has statutory authority to promulgate rules regulating tattooists and tattooing establishments, per Wis. Stat. § 463.10(4).
No person under 18 years of age may be tattooed, except by a physician in the course of the physician’s professional practice, as permitted under s. 948.70 (3), Stats.
A tattooist may not tattoo a person who appears to be under the influence of alcohol or a mind-altering drug or a person who has evident skin lesions or skin infections in the area of the procedure.
Every tattooist shall keep a record of each patron, which shall include the patron’s name, address, age and consent form, the name of the practitioner doing the procedure and any adverse effects arising from the procedure. A patron’s record shall be retained for a minimum of 2 years following completion of the procedure.
Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for microblading and must be disclosed and discussed with the specialist prior to treatment.
Please follow these instructions for 10-14 days after the procedure to improve and prolong the results. If you don’t follow these instructions, it could greatly affect your microblading results.
Topical Anesthetic Advice
Allergic reactions can occur from any anesthetics used during the procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other symptoms associated with an allergic reaction.
Numbness – We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to skin type. Some clients report the area to be completely numb, while others may experience some discomfort.
Procedure – For microblading procedure, a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy/chemist. The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to treatment. As a result of the treatment, combined with the use of the anesthetic, you can expect to experience some redness/swelling that can last 1-4 days. You should always follow your post procedure advice and after care for the best results.
Tap or click on the signature above to sign
Tap or click on the signature area above to sign.
I grant permission to ALUNA TRENDS for the use of the photograph(s) or electronic media as identified below in any presentation of any and all kind whatsoever. I understand that I may revoke this authorization at any time by notifying ALUNA TRENDS in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived.
Select your PMU artist:
