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    Certified Permanent Cosmetic Professional   Society of Permanent Cosmetic Professionals

Facial Art by Jane
2942 N 24th Street #201
Phoenix, AZ 85016
602 952-7678

[email protected]

We accept all major credit cards
    I serve clients from all over Phoenix, Tuscon, Cave Creek, Chandler, Gilbert, Glendale, Paradise Valley, Peoria, Queen Creek, Mesa, Scottsdale, Tempe Arizona and from all over the United States.
My Paper Work Has Paper Work! Does Yours?
By Jane Adler

Has your paper work grown over the years? Mine has. In 1994, I had one page for clients to sign. Now in 2004 my paper work seems to have multiplied. This is actually a good thing. Be prepared for most scenarios in advance. I am going to share a break down of forms to have on hand at all times. One can never be too prepared and you can even have fun with color coordination. To date, I have never had to prove myself. I hope is one reason.

First, I have my every day client file pack. This consists of one manila file folder, one pre and post care written instructions (green), one medical profile and general consent form (white), follow up visit form (yellow) and a record sheet (pink). To make it fun all my client files have a white, pink, green and yellow. This also makes it very easy to remember all important forms to be utilized.

All clients go home with an after care pack (green). This includes clean q-tips and my post ointment of my choice. Clients love to leave with there own little gift. Each bag has a label with contact information.

I also have after care sheets pre-prepared for salt removal, scar camouflage, vitiligo and areola restoration.

Here is a break down of the basic paper work to keep on hand:

1. Client registration and consent
2. Client follow up visit to initial session (yellow)
3. Previous work consent (baby blue)
4. Additional consent to have or decline a allergy patch test
5. Comment page for client to word desires and initial for special consent
6. Form for a client to have doctor fill out when warranted (orange)
7. Consent for scar, areola, vitiligo or salt removal if applicable
8. Pre and Post Care instructions (green)


1. Model consent (purple)
2. Model evaluation of class (blue)
3. Student evaluation of class
4. Trainer evaluation of student
5. Student record sheet

Here are ten fun samples of what all forms should have. Please check your local and state laws. Check with your insurance carrier and attorney to personalize.

1. This agreement is part of the original appointment_________. I understand this is a complimentary session to complete original work. There is an additional fee for all future appointments as specified in original agreement. Initial________________.

2. I understand that there is a rare risk of infection, miss placed pigment, allergic reaction, swelling, fever blisters and or corneal abrasion with any cosmetic tattoo and or color change. Initial_____________

3. I understand that Jane Adler cannot guarantee the outcome of any permanent makeup procedure due to the unpredictability of the human skin.

Initial _____________________

4. Are you pleased with your permanent makeup applied by Jane Adler with Everlasting Facial & Body Art Yes or No

5. _________ I understand this paper work is part of my confidential client record for Jane Adler. (HIPPA)

* Jane Adler will use a fresh pre-sterilized needle(s) and pigment for all procedures. Jane Adler follows all OSHA standards on all clients. Fresh gloves are worn for all procedures!

I understand there will be no refunds upon treatment for this elective procedure(s). I understand my payment includes _______________ visits within 45 days of initial application. It is the responsibility of the client to contact Jane Adler with in 45 days after initial session if a touch up is required. Additional visits for Touch ups will require further payment of: * Be sure to book Touch up if needed after initial application with in 45 days!!!!!! Additional touches up fees are: This will range on an individual basis from 1 to 10 years. If you do not book a follow up appointment in the time allowed you will forfeit your complimentary follow-up and be charged the below fees. Eyes $150.00, Brows $150.00, Lips $200.00, Other ________.

6. Client authorizes Jane Adler unrestrictive use of before and after photographs to include but not limited to portfolio and teaching. Initial___________________________ * I must have a picture of all clients

7. I understand that a patch test does not guarantee that, I may not develop an allergic reaction in the future. Initial _____________

8. ________________ I understand Vitiligo can spread with any trauma, including tattooing.

9. ________ I understand that implanted pigment can turn color or fade over time due to circumstances beyond the control of Jane Adler and alter the original pigment color. I understand I will need to maintain the color with future applications. Sun, skin care products, pools and other factors play a role in pigment fading on the face. An allergic reaction can occur, most common with topicals and after care.

10. ________ Initial. I understand that while having permanent makeup applied by Jane Adler over my previous work, there can only be limited improvement. There can be scar tissue from previous tattoo work and the remote possibility of an allergic reaction to pigment already implanted. When tattoing over previous work there is a chance the new tattoo applied will not yield strong results. Jane Adler will do everything possible to enhance my previous permanent makeup, however, cannot guarantee the out come and I am willing to proceed with the procedure(s). This includes lip augmentation like collagen and other products injected into the lip tissue prior to lip tattooing.

I hope these tid bits are helpful. I have my calendar pre-marked to update my forms ever January and as our great industry faces new challenges, I adapt to the moment.

It is also advised to have a nice area for clients to sit and relax while filling out their paper work. A well educated client is a happy client

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