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PMU Services Intake Questionnaire

Taboo Tushie, Yoni Steam, Ritual Kits, Herbs, Crystals, PMU, Paramedical Tattoo, Scar Camouflage, Permanent Make Up, Reiki, Hair Cut, Hair Color, Mushrooms, Psilocybin, Jewelry, Earrings, Artwork, Nipple Tattoo, Areola RePigmentation, Tarot, Tarot Reading, Ritual, Lip Blushing, Eyebrow Tattoo, Reiki Master, Pranic Healer, Microdosing, Macrodosing

I acknowledge by submitting this release form that I have been given full opportunity to ask any and all questions which I might have about obtaining a tattoo and/or skin needling from Taboo Tushie. All of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth and I agree. Micro-pigmentation is a process of implanting pigment into the dermal layer of skin. Micro-pigmentation is a form of tattooing used for the purpose of permanent cosmetic make-up and skin imperfection camouflage. I have requested these procedures and agree fully to the terms.

I voluntarily request Taboo Tushie to perform the following procedure(s):

Select Your Services:

Photographs will be taken before & after the procedure for client records. Taboo Tushie is able to conceal your identity if requested. Please let us know if we're able to use photos for websites, social media’s and to show future clients or students.

I acknowledge that the markings in todays procedure are permanent and change my appearance. Variations in color and design may exist between any tattoos selected by me and as ultimately applied to my body. I have been told that there is a risk of infection following the procedure.

I am fully aware that there will be NO Refunds for this elective procedure under any circumstances. I also acknowledge that there will be an additional Fee at all ‘touchup’ or “perfecting” appointments.

I have truthfully and accurately completed the medical history form. (link at bottom of page if you need it again)

I have been honest in revealing any condition that could prohibit or alter my procedure as such, but not limited to, pregnancy, recent surgeries, sun exposure\tanning, cold sores, tendency of scarring, breast-feeding and use of any Accutane in the last 12 months.

I understand that there are no warranty’s or guaranteed results from these types of tattoos or skin needling procedures, many variables such as age, sun damage, prolong sun exposure, smoking, excessive alcohol intake, climate, oily skin, diet, an increase water intake may reduce the effects of my treatment.

Regardless of precautions taken, I acknowledge the possibility of an adverse reaction to the treatment and claim/accept sole responsibility for any medical care that may become necessary. I will immediately inform Taboo Tushie of any adverse reactions, and seek medical attention if needed.

I acknowledge that tattoo inks, dyes and pigments have not been approved by the Federal Food and Drug Administration and the health consequences of using these products are unknown.

In the application and removal process of permanent make-up the epidermal layer to the skin is penetrated. Some of the potential side effects include but are not limited to: discomfort, swelling, redness, hyper pigmentation, hypo pigmentation, eye injury, corneal abrasion, scarring and infection.

I understand that there is a chance for pigment migration. This is where the pigment moves out of the designated area being treated to an area where pigment may not be desired.

I agree, that should I have a complaint of any kind whatsoever, I shall immediately notify Taboo Tushie and further agree that any controversy or claim arise out of or related to this consent and/or any signed contract between myself and Taboo Tushie and its affiliates/ workers/ employees or the breach there of, shall be settled by arbitration in the state of Louisiana in accordance with the rules of the American Arbitration Association and judgment of the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

I agree to release and forever discharge and forever hold harmless Taboo Tushie, Tasha Daigle, and her associates, agents, officers, and shareholders from any and all claims, damages, or legal action arise from or connected in anyway with my tattoo procedures and conduct used to apply my tattoo and any and all tattoos applied by Taboo Tushie and it’s associate agents and representatives in the future.

I have received a copy of the post procedure instructions. It has been fully explain to me and I have read it, or it has been read to me. I understand its contents.

Upon signing this form, I acknowledge that I have read this form, that I fully understand its contents and that I have been given ample opportunity to ask questions and that all of my questions have been answered to my satisfaction.

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