top of page

Disclosure and Consent  Contract

Please fill out the following form
in order to participate in our activity.

I acknowledge the manufacture of the pigment suggests spot testing and specifically disclaims any responsibility for any adverse reaction to applied pigments. I understand spot testing may identify individuals who develop an immediate reaction to pigment, however, spot testing does not identify individuals who may have delayed allergic reactions to pigment.
I agree to waive a spot test prior to application and I agree to release Arch Assassin, assistants, and pigment manufacture(s) from any and all liability related to allergic reaction or any other reaction to applied pigment(s).
I have been told that this procedure will involve some level of pain and discomfort.
I understand the markings are semi-permanent and that there is the possibility of hyper-pigmentation resulting from the procedure, especially in individuals prone to hyper-pigmentation, scars, or other injuries.
I understand other risk involved with the procedure may include, but are not limited to: infections, allergic and other reactions to applied pigments, allergic and other reactions to products applied during and after the procedure, fanning or spreading of the pigment (pigment migration), and fading of color.

I accept full responsibility for any and all, present and future, medical treatments and expenses I may incur in the event I need to seek treatment for any unknown reason associated with this procedure.

I have been given/will be given an opportunity to ask questions about the procedure(s) and the risks and hazards involved, and I believe that I have sufficient information to give informed consent.

I agree that should I have a complaint of any kind whatsoever, I shall immediately notify Arch Assassin and I future agree that any controversy or claim arising out of or relating to this consent and /or any signed contract between myself and Arch Assassin or the breach thereof, shall be settled by arbitration in the state of Florida on accordance with Rules of the American Arbitration Association and judgment of the award rendered by the arbitrator(s) may be entered in any court that has jurisdiction.

I understand that if I have an infection, adverse reaction, or allergic reaction to the procedure, I must notify Arch Assassin, a healthcare provider, and the Florida Department of Health Services.

I certify that I have read or had read to me, this consent and I fully understand its contents.

POST PROCEDURES INSTRUCTIONS:

(YOU WILL RECEIVE INSTRUCTIONS TO TAKE HOME)

 

For all Intradermal Cosmetic Procedures:

  • Immediately following treatment apply ice to the area(s) for 10-30 minutes. Ice helps reduce the swelling and aids in the healing process.

  • DO NOT RUB or PICK at the epithelial crust, allow it to flake off on its own. There should be absolutely no scrubbing, cleansing creams, or chemicals used. Gently rinse the treated area with mild antibacterial soap, rinse with water and pat dry. DO not expose treated areas to the full water pressure of a shower until the area is healed.

  • Do not soak treated area in a bath, swimming pool, or hot tub. Do not swim in fresh, salt, or chlorinated pool water for at least 2-4 weeks following your procedure.

  • Limit sun exposure for 14 days following your procedure.

  • Use sterile bandages and dressing when necessary.

  • You will not be allowed to donate blood for one (1) calendar year following your procedure, per the guidelines of the American Red Cross.

I understand that the price is ONLY for the first visit. (Consult/Procedure)

I understand that I will need to schedule my second visit six (6) weeks after my initial visit.

I understand that during the healing time, the pigment may fade or disappear and I may have to touch-up my eyebrows with my usual eyebrow pencil to fill the shape in between visit one (1) and visit two (2).

I understand that this is a two (2) step treatment. After the first visit, I will allow the eyebrows to have proper healing time for a minimum of 6 weeks until the second visit. If I do not book the second visit, I understand the treatment is half done and this is a non-refundable procedure.

I understand the second visit will be $80.00

I understand that I have the option of a third touch-up for an additional price of $80

I understand any additional appointment scheduled between 6 months and 12 months is $125

FAILURE TO FOLLOW POST PROCEDURE INSTRUCTIONS MAY RESULT IN LOSS OF PIGMENT, DISCOLORATION, OR INFECTION, REMEMBER THAT THE COLORS WILL APPEAR BRIGHTER IMMEDIATELY FOLLOWING THE PROCEDURE AND WILL SOFTEN AS THE HEALING PROCESS OCCURS.

I have read or have had read to me, the above post procedure instructions and I fully understand the information contained therein.

bottom of page