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PLEASE READ AND AGREE BELOW* *

MEDICAL + PREP RESPONSIBILITY I understand it is my sole responsibility to obtain an antiviral prescription from my doctor before my lip blushing procedure. If I choose not to take it, I acknowledge the increased risk of: Cold sore outbreak Poor pigment retention Infection Excessive scarring Undesirable results I understand my provider is not responsible for any cold sore outbreak or complications if I choose not to follow this recommendation. RISKS + PROCEDURE UNDERSTANDING I acknowledge that lip blushing is a tattoo procedure and carries potential risks, including but not limited to: Discomfort, swelling, bruising Asymmetry or uneven pigment Infection or allergic reaction Scarring or hyperpigmentation Pigment fading, spreading, or shifting over time I understand that: Pigment color may change or fade due to lifestyle, medications, and skincare. A touch-up is required within 60 days to complete the process. Results are not guaranteed, and touch-up appointments are an additional charge. There are no refunds for this elective procedure or for deposits made. A yearly maintenance touch-up may be needed. LIP-SPECIFIC CAUTIONS Cold Sores: Lip blushing can trigger cold sore outbreaks. If I have a history of herpes simplex, I must take an antiviral 5 days before and 5 days after. Hyperpigmentation: There is a higher risk in deeper skin tones (African, Caribbean, Latin, Mediterranean, Asian). Chapped Lips: I must exfoliate and hydrate lips daily for 1 week prior. Dry lips may affect healing and retention. MEDICAL CONDITIONS TO DISCUSS I will inform my technician if I have or have had any of the following: Common Conditions: Allergies, anemia, asthma, thyroid, alopecia, cold sores, etc. Higher Risk: Autoimmune disorders, diabetes, cancer, blood thinners, HIV/AIDS, lupus, vitiligo. Contraindications: Pregnancy, hepatitis, active cold sores, keloid scarring, contagious diseases, recent use of Accutane, etc. CANCELLATION + RESCHEDULING A $200 non-refundable deposit is required to book your lip blushing appointment. If you cancel/reschedule and do not complete your initial touch-up within 2 months, you will be charged an additional $500. A 48-hour notice is required for cancellations. Any changes within 48 hours will incur a $100 cancellation fee. No-shows or last-minute cancellations after the second offense will require prepayment for future services. If you arrive unprepared (e.g., active cold sores, chapped lips), your service may be refused, and a $100 fee will apply. If you arrive and decide not to proceed, you will still be charged the full service fee. Children under 18 are not allowed in the office. All clients must have a valid card on file to book. PHOTO CONSENT + LIABILITY I understand that before/after photos are required for documentation. FINAL ACKNOWLEDGEMENTS By signing below, I confirm that: I have been fully informed of the nature, risks, and possible outcomes of this procedure. I understand this is not an exact science, but an art. I will follow all pre- and post-care instructions provided. I accept full responsibility for my decision to undergo cosmetic tattooing. I have had the opportunity to ask questions, and all my concerns have been addressed.

I AGREE AND UNDERSTAND THE ABOVE TERMS AND ASSUME ALL RESPONSIBILITY