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Consent Forms- Med Spa at Villagio
Medical, Salon, Day Spa, Nail, Hair, Body Massage Salon Katy TX
I,am over the age of 18, am not under the influence of alcohol, am not pregnant or nursing, and desire to receive a permanent cosmetic procedure. The general nature of cosmetic tatooing as well as the procedure, has been explained to me.
I,am under the age of 18, and have the presence of a parent or gaurdian in order to receive this permanent cosmetic surgery. I am not under the influence of alcohol, am not pregnant or nursing, and desire to receive this permanent cosmedic prodecure. The general nature of cosmetic tatooing, as well as the proceure, has been explained to me.
PROCEDURES(S) NO. OF VISISTS REQUIRED
COST OF PROCEDURE(s) PROCEDURES(S) NO. OF VISISTS REQUIRED
PLEASE READ AND CHECK THE BOXES WHEN YOU ARE CERTAIN YOU UNDERSTAND THE IMPLICATIONS OF SIGNING. In consideration of receving permanent make-up, TRANG LEE, the practitioner at Med Spa Villagio INC, together with its apprentices and agents. I
confrim the following by initialing each applicable item:
I am the person on the legal ID presented as proof that I am 18 years of age.
I am not under the influence of alcohol or drugs and I am voluntarily submitting myself to receive this procedure with out coercion.
I understand the permanent nature of receiving permanent make-up and the removal of can leave scars.
All questions about the permanent make-up or the procedure have been answered to my satisfaction.
I understand ant medical information obtained will be subject to the federal Health Insurance Act of 1996 (HIPPA).
I agree to follow all instructions concerning the after care of my permanent make-up procedure or application.
I agree to release and discharge and hold harmless Med Spa Villagio INC, and its associates, agents, and shareholders from any and all claims, damages, or legal actions, arising and concerning permanent make up procedures done at MedSpa Villagio Inc.