Pre-Treatment Consent Form

CONTACT INFORMATION

Full Nameyour full name

Phone NumberYour phone

Emaila valid email

Your Date of birthof appointment

Your residential addressyour full name

MEDICAL QUESTIONS

Do you have any allergies?

YESNO

History of cold sores/herpes?

YESNO

Are you currently pregnant or breastfeeding?

YESNO

Do you have any skin conditions (eczema, psoriasis, dermatitis)?

YESNO

Taking any medications?

YESNO

What medications are you currently taking? Please list their names. ( if you don't use any please type N/A).

0 /

Taken Accutane or acne medication in last 12 months?

YESNO

Have you done Botox, filler, microneedling, chemical peel or laser in the last 4 weeks?

YESNO

Any previous permanent makeup or tattoo on the area?

YESNO

Do you have a history of keloids or abnormal scarring?

YESNO

Do you have a history of cold sores (Herpes simplex)?

YESNO

SERVICES SELECTION

MEN OR WOMENSERVICES YOU WILLING TO TAKE

MENWOMEN

Which service are you receiving today?Men Services

SMP – Scalp & Beard Micropigmentation (For Men)Men’s Lip Neutralization (Anti-Dark Lip Treatment)Lash Enhancement Tattoo (For Men) Tattoo RemovalBody TattooBrow Lamination + TintMicroblading

CLIENT CONSENT

Please tick to confirm:select them all

I understand the procedure and possible temporary side effects (redness, swelling, irritation).I confirm that all my medical information provided is true and complete.I understand that results vary and multiple sessions may be needed.I agree to follow all after-care instructions.

LIABILITY WAIVERTick to confirm

I release Taran Nika Beauty from liability for reactions or results caused by undisclosed medical conditions, allergies, or failure to follow after-care.