Informed Consent for Pigment Lightening & Removal (Think! Pigment Remover)

Outline of procedure and acknowledgement of risks involved:

The nature and method of the proposed pigment (tattoo) lightening procedure involves introducing a liquid removal product into the skin using a cosmetic tattooing device. The philosophy is that the pigment comes out the same way it went in. There are many factors affecting how successful the procedure may be and the number of treatments that may be required to achieve the desired result. Complete removal is rarely necessary and can be difficult to achieve.

The combined actions of the cosmetic tattoo device and the liquid removal product dislodge and dissolve pigment. Factors such as pigment age, type, depth of placement, skin type and skin integrity will all influence the ease of pigment removal and number of treatments required.

There are risks and possible complications during or following the procedure. You acknowledge that there may be a certain amount of discomfort or pain associated with the procedure. Other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling. Cold sores may occur on the lips following lip procedures in individuals prone to this problem. Secondary infection in the procedure area may occur, however if properly cared for, this is rare.

You understand the nature of the procedure and the potential risks and complications.

You understand that several treatments may be required to try and achieve my desired results. I have not received any guarantees on the of the outcome of the process.

You understand there are medical and other options available for cosmetic tattoo pigment removal. I have decided to decline those methods.

You understand that the pigment may not be successfully lightened to the point that it can no longer be seen. Scarring, hyperpigmentation or hypopigmentation, discoloration 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 or the COMPANY responsible for any such consequences.

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

Acknowledgement

You have been duly informed of the natures, risks, possible complications, and consequences for the procedure, including the potential need for multiple treatments, if applicable. I further understand that my technician is not a medical doctor or other healthcare professional and is not providing medical advice, for which I would need to consult with a medical professional.

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