1 Step 1
SPMU Consent Form

Please choose from the options below and fill out your personal semi permanent makeup consent form. 

Treatment Area
I would like the effect to be:

Medical Conditions:

1 CHEMOTHERAPY (LAST 12 MONTHS)

2 UNDIAGNOSED PAIN/LUMPS

3 HAEMOPHILIA

4 MEDICAL OEDEMA

5 LOW/HIGH BLOOD PRESSURE

6 EPILEPSY/SPASTIC CONDITIONS 

7 KIDNEY INFECTION

8 RADIOTHERAPY ( LAST 12 MONTHS)

9 HERPES SIMPLEX (COLD SORES)

10 NERVOUS SYSTEM DYSFUNCTION e.g. multiple sclerosis, Parkinson disease, motor neurone disease -CARDIOVASCULAR

11 CONDITION e.g. thrombosis, phlebitis, hyper/hypo tension, heart condition 

12 ASTHMA CONDITIONS

13 CANCER

14 PSORIASIS (medical note)

15 RECENT OPERATION 

16 UNSTABLE DIABETES
17 EYE/LIP INFECTION
18 HYPERTROPHIC/KELOID SCARS

19 ANTIBIOTICS IN THE LAST 4 DAYS

20 PAINKILLERS IN THE LAST 48 HOURS

21 IMPAIRED SKIN IN THE TREATMENT AREA

22 ROACCUTANE/TRETINOIN TREATMENT IN THE PAST 3 MONTH

23 APPLYING ACTIV SKINCARE TREATMENTS LIKE CHEMICAL PEELS OR VITAMIN A/RETINOL IN THE LAST 2 WEEKS 

24 SUN EXPOSURE/SUNBED/FAKETAN IN THE LAST 2 WEEKS

25 Botox injection in the treatment area in the past 4 weeks

26 Dermal filler in the  treatment area in the last 4 weeks

27 History of alergic rections

28 Allergic to lidocaine, glycerine, dyes, anaesthetic, metals


If any points mentioned above relate to you, please enclose details below:

Permanent Makeup, Semi-Permanent Makeup, Cosmetics Tattooing and Micro-pigmentation is a form of tattooing.

• Retouch procedures will be required, as post the pigment can be between 30-50% lighter than the desired shade/result.
• Pigments will fade in time.
• Although rare, pigments may migrate under the skin.
• Allergic reactions to pigments are possible although rare. A negative patch test will not necessarily guarantee that you will not have an allergic reaction.
• Swelling, minor bleeding and infection can occur.
• Permanent Makeup procedures can be painful with mild sensation post aesthetic cream experienced in
some cases.
• It is possible although rare for corneal abrasion to occur during an eye-liner procedure.
• Sufferers prone to Herpes Simplex (cold sores) may experience an outbreak/re-occurrence after lip pro-
cedure.
• Clients should not drive immediately after an eye treatment.
• Lips will appear flaky and be dry post treatment for up to one week.
• Camouflage procedures will need to be tested for skin colour matching.
• Scarring, inconsistency of colour and loss of eyelashes after a lash treatment.

Consent Declaration

I confirm and consent that the above information that I have completed regarding my personal information, emergency contact information, treatment contraindications, medical history, medical conditions are true.

I confirm that I have provided written permission and a GP's letter where required relating to circumstances where medical permission was required.

I confirm my agreement of taking pictures of lips and/or brows and eye-liner.

I confirm my agreement of sharing pictures on social media.

I am over 18 years of age. 

I confirm that I am not under the influence of drugs or alcohol and do not have mental or physical impariments that may affect my ability as to whether to have the procedure carried out.

I confirm that I have read and understood the sensitivity patch test and topical anaesthetic consent form and have carried our a patch test for pigment and topical anaesthetics at least 24 hours before this appointment as instructed, reporting the results to my therapist/technician and understand that if I do not wait a full 24 hours after the patch test to receive the procedure technicians, or the salon cannot be held responsible for any adverse reactions experienced.

I understand that permanent makeup procedure results vary from person to person depending on numerous factors such as skin characteristics, PH balance, lifestyle, medications and post procedure after-care. If the end result is not what I expected I have no automatic rights to make requests for changes unless agreed by the technician.

understand that lip procedures may stimulate and trigger dormant viruses, conditions or infections (herpes simplex).

I authorise the therapist conducting my treatment to determine the colour, shape, style and position of my eyebrows, eye-liner or lip liner or other procedure during the course of my consultation.

l understand that initial re-touch must be carried out between 4-12 weeks post treatment. Additional service fees will be charged for this treatment which must be booked in advance to guarantee availability. True colour should be seen approximately 4 weeks after the procedure although this is never guaranteed.

I understand that post-treatment swelling, bruising and redness may occur however will generally subside within 4-5 days. Post treatment after-care provided by the technician must be followed and post treatment healing balm applied to a makeup free treatment area following the procedure with all forms of sports and spa/sauna visits and directly sunlight being avoided during the healing process of 4 weeks.

I confirmed that I have read and understood all information outlined in this client consultation form.

I Consent To The Above
*Check Junk Mail For Your Copy*
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right