This is a consent or procedure agreement entered into on , by and between (Client) and Permanent Enhancements LLC (PE), located at 7373 Austin Powder Drive, Glenwillow, OH 44139.

The procedure is a form of a tattoo that utilizes a pigmentation procedure to apply colorants just below the skin, in a similar manner as a traditional tattoo. This procedure is considered "permanent" as it cannot be readily/easily removed. The procedure will require a minimum of two sessions with PE to complete. The number of sessions required will depend on client's skin type, hair tone, and reaction to the colorants. Maximum procedures not to exceed 4 sessions without further consent and/or service agreement contract. If client complies with all the terms and conditions of this agreement and follow the written "aftercare instructions. PE will provide a twelve-month limited warranty on the procedure. If fading occurs within this 12-month period, and client has complied with the terms of this agreement, then PE will touch up client's scalp at no additional charge. PE cannot give or provide any guarantee to procedure outcome.

Client hereby acknowledges and agrees that the procedure is an elective treatment and there is no medical reason that requires him/her to proceed with it. The procedure is being performed on the client at his/her own risk. The procedure, like any tattoo carries a multitude of risks and by signing this agreement client accepts these risks, including but not limited to the following: Allergic reactions, infection, scarring, inconsistent color, spreading/fanning or fading of pigments. Granulomas, keloids and hyper/hypo pigmentation (lightening or darkening of the skin). Although rare, client must understand any of these conditions could arise. Removal of any such tattoos can be difficult and costly and the success of reversal is not guaranteed and will be done at Client's expense.

CONSENT TO APPLICATIONScalp Micropigmentation

The Permanent Way to a More Beautiful You

City

CLIENT INFORMATION Street Address Phone Email

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May we Text you? YES May we Email you? YES NO

The fee for this procedure, $ , Is based on the area to be treated and includes aforementioned required sessions, not to exceed four treatments, and is agreed upon by Client.

Client is 18 years of age or older.

Client is not pregnant or nursing.

Client will strictly adhere to the aftercare instructions.

Client will use SUNBLOCK or COVERING such as a hat when in direct sun.

Client represents that he/she does not have any medical or skin conditions on his/her scalp that could affect the result of the procedure, including but not limited to acne, scarring (keloid), Eczema, Psoriasis, rashes, freckles, moles, sunburn, open cut, wounds, or any other matter or condition which may affect client's suitability as a candidate for procedure.

Client will not use hair growth stimulators/acids/DHT blockers.

Client agrees that photographs of the facial area and scalp will be taken before, during and after the procedure and become the property of Permanent Enhancements LLC to be used as needed.

In the event that client cancels or changes appointment without giving the required 72 hours (3 days) notice will result in a cancellation and or rebooking fee of up to $250, at Permanent Enhancement's discretion.

Client certifies that they have read and initialed the paragraphs here within and have had explained to their understanding this consent procedure agreement and accepts full responsibility for the decision to have this cosmetic tattoo work done.

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Date Hand Signature __________________________

Digital Signature __________________________

CONSENT TO APPLICATIONScalp Micropigmentation

The Permanent Way to a More Beautiful You