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Laser Tattoo Removal

First name

Last name

Phone

Birthday

Month

Day

Year

Drive License

Drive License File upload

Ink Brand or Color ( if you know it)

How Old is the Tattoo?

Reason of the Removal

Health and Medical History:

(To ensure your safety, please answer the following questions.)

Are you pregnant or breastfeeding?

YES

Do you have any allergies (e.g., latex, pigments, anesthetics)?

YES

Do you have a history of cold sores, fever blisters or keloids?

YES

Are you currently taking any medications, including blood thinners, antibiotics, or fish oil?

YES

Have you consumed alcohol or tetrahydrocannabinol (THC) in the past 24 hours?

YES

Have you eaten 2 hours prior to the appointment

YES

Have you consumed aspirin, ibuprofen, allergy medicine or fish oil in the past 24 hours?

YES

Potential Risks & Contraindications:

I understand that I am receiving a laser tattoo removal procedure and that results may vary depending on skin type, lifestyle, and adherence to aftercare instructions.

I understand that achieving optimal results may require multiple sessions, and laser tattoo removal typically requires a minimum of 3-10 sessions, with the initial session followed by further treatments based on progress and desired results.

I understand that laser tattoo removal may cause minor discomfort, but it is generally well-tolerated. Numbing creams or local anesthetics may be used to minimize discomfort during the procedure.

I understand that laser tattoo removal may cause temporary redness, swelling, or may blisters in the treated area. These effects should subside within a few hours to a few days after treatment.

I understand that the only way to completely remove a tattoo is through laser tattoo removal. This service is available at Posh Permanent Makeup LLC for an additional fee and may require multiple sessions to achieve the desired result.

I understand that scarring, infection, color changes, and skin damage may occur if aftercare instructions are not followed or if the procedure is not performed properly.

I understand that aftercare is essential to the healing process and must be followed to avoid complications and ensure the best results. Instructions include but are not limited to:

Avoid touching the treated area unnecessarily.
No swimming, hot tubs, or direct water exposure for at least 2 weeks.
Avoid excessive sweating or exercise for 7-10 days.
No facials, chemical peels, or other skin treatments for 2-4 weeks.
Apply any recommended ointments as directed.
No makeup application on the treated area.

Consent and Waiver:

By signing below, I certify that all the information provided is accurate and complete to the best of my knowledge. I have read and understand the above information and give my consent for the procedure.

Signature

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