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Permanent Makeup Consent and Waiver

Select the procedure you are having today?
Select all/any medical conditons you have currently or in the past
Have you been hospitalized or undergone any surgeries in the last 12 months?
Are you suffering from a medical condition, illness, or injury?
Have you had any drugs, alcohol or caffeine in the last 24 hours?
Have you had any exposure to radiation or any other medical interventions?
Are you currenlty taking blood thinners
Are you pregnant or nursing?
Do you wear contact lenses?
I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure

Muse Parlour

11892 Hero Way West Leander, TX  78641





MUSE PARLOUR is obligated to perform procedures in strict compliance with all hygiene and health protection measures. This information is confidential, and it shall also be handled in that way. MUSE PARLOUR AND ITS ASSOCIATES  assumes no liability in the case of giving false information.



The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.  

If I suffer from hepatitis or other risk factors from Bloodborne Pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medications and procedure(s) necessary to promote the satisfactory healing of my permanent make-up tattoo. 


I acknowledge that obtaining this indicated permanent cosmetic procedure is my choice alone

. The application of permanent make-up will result in a permanent change to my appearance, and that needles and pigment will go into my skin.

No representations have been made to me as the ability to later restore the skin involved in permanent-makeup to the original condition, and it is very costly to remove.                       

The pigment is absorbed differently due to differences in the skin quality, thus there is no guarantee or warranty for the success of treatment.                    

I acknowledge that tattoo ink, pigments have not been approved by the FDA and that the health consequence of using these products are unknown. You might take a 5-7 day patch test to determine this.

Please inital to : Waive                          or Take a patch test                     

A 5-7 days patch test is advisable however it does not ensure a client will not have an allergic reaction. If waived, I release the technician from liability if I develop an allergic reaction to the pigment. I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color, and spreading, fanning or fading of pigment. During the procedure despite the staff expertise and all the precautionary measures, injury is possible.              


    I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.                   

Permanent make-up always leads to skin injury. Therefore, it is important to carefully and gently nurture your skin after the treatment to allow healing without complications. Inadequate care in the healing phase of the skin can lead to poor results and MUSE PARLOUR and the technicians cannot be liable for it                 

ANESTHESIA: Topical anesthetics are used to numb the area to be tattooed. Lidocain, Prilocain, Benzocain, Tetracaine, Espinephrine in the cream or gel form are typically used. If you are allergic to any of these inform your technician NOW.                      

MRI: Because pigments used in permanent cosmetic procedures contaitn inert oxides, a low level magnet may be required if you need to be scanned by an MIR machine. You must inform your technician of any tattoos or permanent cosmetics.

I understand and agree to before and after photos taken of the procedure(s) are required.         

By signing below, I agree to the procedure discussed. I certified that I have read and initialed the above paragraphs and have full explanations to my understanding and consent to this procedure(s).

I accept full responsibility for the decision to have this cosmetic tattoo work done and understand that Permanent Make-up is an art, NOT a science and all clients’ results will vary, therefore ABSOLUTELY NO REFUNDS AFTER ANY SERVICES WILL BE GIVEN 



PAIN: There is a possibility of pain or discomfort even after the topical anesthetic has been used. Anesthetics work better on some better than the others.

INFECTION: Although rare, there is a risk of infection. The areas treated must be kept clean and only freshly cleaned hands should touch the area. Client has been provided aftercare instructions.

UNEVEN PIGMENTATION: This can be result from poor healing, infection, bleeding or many other causes. You follow up appointment will likely correct any uneven appearance.

ASYMMETRY: Every effort will be made to avoid asymmetry but our faces are not eymmetrical so adjustment may be needed during the follow up session to correct any unevenness. 

EXESSIVE SWELLING OR BRUISING: Some people bruise and swell more than others. Ice packs may help and the bruising and swelling typically disappears with 1-5 days. Some people do not bruise or swell at all.

WHILE YOUR SKIN HEALS, BE PREPARED FOR THE COLOR INTENSITY OF YOUR PROCEDURE TO BE SIGNIFICANTLY LARGER, SHARPER, BRIGHTER, OR DARKER than what is expected for the outcome and it’s normal expectation of the healing process. The healing process will take a number of days to complete, depending on how quickly the outer layer of your skin exfoliates and new skin regrows to take its place.

In the first seven days eyebrows are up to 40% darker and 10-15% thicker due to color oxidation. Color reflection depends on the natural skin pigment. The color CAN AND WILL fade/soften from 10% to 50% or more after about 4 to 6 weeks. Some residual swelling, redness and/or itching might occur, is normal and healing time is individualized and will vary from person to person. Blanching (whiteness around the treatment area) and redness is to be expected and can vary from client to client. 

    You will need a color boost every 1 to 2 years to maintain its fresh natural appearance. Fading WILL happen after each procedure. We do not have control over your body's healing process. Everyone’s genetics, physiological make up, and life style will affect the treatment in various unique ways. If you are out in the sun a lot, have oily skin, use anti-aging creams, Retin-A /retinol products, acidic cleansers, natural elements, regular chemical peels, or exercise frequently, your permanent makeup WILL fade prematurely. The better you take care of the treated area and follow the provided aftercare, the longer it will last.

Remember, that no two sides of the face are the same or perfectly symmetrical, your face is not symmetrically PERFECT. Remember your technician will do their best to help you heal properly but lifestyle, genetics, age, and certain environmental factors can/will contribute to the retention of your eyebrows. It is very common to have areas fade more so than others. Previously done permanent makeup may take 1-3 treatments to achieve the desired result. Scar tissue in the brow area of pervious permanent makeup done multiple times WILL require additional procedures and fees will apply. 

Permanent Make-up is not a “no maintenance” treatment but a “low maintenance” one. If you decide to change your mind, you will be charged accordingly for the change of service.

Most of the color may fade about 30% to 50% within 4 weeks. For oily skin it may be necessary to perform more correction. You will need to consider a touch up appointment 6 to 8 weeks after your initial treatment and fees may apply.

WE DO NOT OFFER FREE TOUCH UPS for the FOLLOW UP visit - but will be priced accordingly to your individual needs.

- Touch up (within 2 months): $100-$150

Note: Result from work by students is not guaranteed. You might need not only 1 but 2 touch-up visits.


In the next 2 weeks after your first procedure is complete, client is required to follow the below aftercare instructions strictly:

Refrain from the treatment area having any contact with water for at least 48 hours after procedure (skip washing your face/your hair).  A thick crust will appear if water makes contact to the treated areas directly and all the pigment will fade.


1st Day: Keep your treated area dry. Clean your treated area with facial tissue damp with distilled water (blot, DO NOT WIPE) every 30 mins to 1 hour. This will help remove any excess lymph, blood and pigment that may appear after the procedure.

2nd Day: Clean your treated area with facial tissue damp with distilled water 2-4 times per days (blot, DO NOT WIPE). Try to keep you treated area dry at least the first 2 days

Day 3rd-10th: Apply Aftercare ointment 2 to 4 times a day until your treated area finishes the scab exfoliation.  Make sure your treated area is not oily or greasy, you need only a very light coat of ointment.  If skin is oily or sweaty, you can apply Aftercare ointment less (1-2 times a day) and make sure you clean the skin when necessary (Witch Hazel if necessary).


• Before applying the new Aftercare ointment , clean your treated area with tisuue and distilled water.DO NOT use any cleansing products containing acids (glycolic, lactic, or AHA). Only use a pin-point drop of aftercare ointment on your clean fingertip and spread it across the area. Do not over-apply the product. The ointment should be barely noticeable on the skin.

Important reminders

In the first 2 weeks:

Keep your treated area dry and clean; do not get your brows directly wet; water, ocean, pool, sweating or any other liquids, avoid swimming pools, sun bathing, tanning beds (no sun or tanning for 30 days), sauna, beauty treatments and intense training accompanied by sweating (sport activities), contact with dirt and dust (Even a small drop of water, liquid which seems unimportant may expand the wound / possible infections / excessive scabbing may appear, and you may ruin the results).

Do not use any other ointments, cream on treated area except the ones provided our recommended to you to prevent possible infections or allergic reactions.

DO NOT PICK THE SCABS during this healing process. Picking can lift color and pigment from the treated area resulting in unevenness and blank spots. Let the treated area flake off naturally. Your treated area may not exfoliate evenly.. During the exfoliation process your color may look weak, orangey, pinkish, or grey and this will not be your final result. It takes a full 6 weeks or more for your true color to surface. Please be patient and wait until you are fully healed before you critique your treated area. Any refinements can be addressed at a follow up visit. 

No direct sun exposure. No Retinols, AHA’s, exfoliating treatments, chemical peels, microdermabrasion, botox and any other strong treatments for 6-8 weeks after your procedure.

Smoking WILL cause the pigment to fade prematurely and anesthetics will not last as long.

DO NOT USE growth enhancement products such as Latisse, Revitabrow, Grande lash, one month prior and after treatment has fully healed, as it may shift your color. 

No sweating (of any kind), gym, yoga, swimming for 2 weeks. If you work out regularly results may heal more to a powdered look due to the oils the body produces when it gets heated and sweaty. 

MUSE PARLOUR and their technicians are not liable in case of improper post-treatment care. _ 

I confirm that I have read and understood the above procedure and aftercare information. 

I received a clear and understandable response to all my questions. 

The treatment procedure and post-treatment care was explained to me in detail and I agree with it. 

After Care instructions (as mentioned above) to take home were given to me. I have read and understood the risks to this procedure. I have read and understand the aftercare protocols after my treatment and promise to follow the aftercare instructions. If I do not follow the aftercare I may ruin the results and the technician and Muse Parlour has the right to release me from any future services.

Thanks for submitting!

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