Permanent Makeup Release Form

Permanent Makeup Release Form
This form seeks to get your consent to use your photos/videos are taken by our company through our therapist or representative.
Signing this form gives us the permission to use your photos/videos for the purposes indicated hereunder.
The refusal of this form by you will not affect the operation or medical care you receive in any way.
Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please select the ones you agree;
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sign
Clear
Should be Empty: