Client Intake & Consent

A few minutes now, a relaxed visit later

Completing your intake and consent forms ahead of time keeps your appointment calm and unhurried. What you share is seen only by Narmela and used only for your care — the one exception is portfolio photos, which are never used unless you tick that box yourself.

1 · About you

Full legal name

Date of birth

Used to confirm you are 18 or over, as the consent form requires.

Phone

Emergency contact (name & phone, optional)

Service you're visiting for

2 · Health history

These questions exist purely for your safety. Honest answers let Narmela tailor the treatment — or advise you when waiting is the safer choice. Your answers are read only by Narmela, kept in the studio's private client record, and never shared or published. If you are not sure about a question, leave it and ask before your appointment — a guess is worth less than a conversation.

Are you currently pregnant or nursing?Do you have diabetes?Do you have a blood or bleeding disorder — anything that makes you bleed or bruise more easily than usual (for example haemophilia, von Willebrand, low platelets)?Do you have a history of keloid scarring — scars that grow raised and thicker than the original cut?Any skin condition in the treatment area — eczema, psoriasis, or dermatitis (itchy, flaky, red or inflamed skin)?Do you get cold sores / fever blisters?Are you currently undergoing chemotherapy or radiation?Do you take blood thinners (including daily aspirin)?

Allergies (medications, latex, lidocaine, pigments…)

Current medications & supplements

Previous permanent makeup in the area (when, where, by whom)

Anything else Narmela should know (optional)

3 · Consent for PMU services

Draft document. This consent form is a general professional draft (version draft-v1) and is pending professional review before use with real clients.

This consent form applies to permanent makeup (PMU) services performed at Narmela PMU Studio, 932 Eglinton Ave West, Toronto, by artist Narmela Malekmohammadi. Please read each section carefully. Your questions are welcome at any time before signing.

1. Nature of the procedure

I understand that permanent makeup (including microblading, lip blush, and permanent eyeliner) is a form of cosmetic tattooing in which pigment is implanted into the upper layers of the skin using sterile, single-use needles. Results are semi-permanent and will soften and fade over time at a rate that varies by individual.

2. Results are not guaranteed

I understand that the final healed colour, shape retention, and longevity of permanent makeup depend on my skin type, lifestyle, aftercare, sun exposure, medications, and individual healing, and therefore cannot be guaranteed. Additional sessions (at additional cost) may be required to achieve or maintain the desired result.

3. Risks and possible complications

I understand that possible risks include: discomfort, redness, swelling, bruising, tenderness, infection, allergic reaction to pigments or topical products, scarring, uneven colour or shape, undesired colour change over time, and reactivation of cold sores (for lip procedures). Some of these — redness, swelling, tenderness — are a normal part of healing. Others, such as infection, allergic reaction, or scarring, are uncommon but possible even when every protocol is followed. I agree to follow all pre-care and aftercare instructions to minimize these risks.

4. Medical disclosure

I confirm that the health information provided in my client intake form is complete and accurate. I have disclosed all medical conditions, medications, allergies, and relevant history (including pregnancy or nursing, diabetes, blood disorders, keloid scarring, and recent cosmetic treatments in the area). I understand that withholding information may affect my safety and my results.

5. Numbing agents

I consent to the application of topical numbing products during my procedure and confirm I have disclosed any known allergies to lidocaine or similar anesthetics — these are the numbing agents used by dentists and for stitches, so a reaction at the dentist is worth mentioning.

6. Aftercare responsibility

I understand that healing outcomes depend significantly on my adherence to the written aftercare instructions provided to me, and that the studio is not responsible for unsatisfactory results caused by failure to follow aftercare guidance.

7. Photographs

I consent to before-and-after photographs being taken for my client record. I additionally choose below whether these photographs may also be used for the studio's portfolio and social media. Such photographs may show the treated area and part of my face, and I may be recognisable in them; my name is never published with them. This choice is optional, it does not affect my treatment, and I may withdraw it at any time by contacting the studio.

8. Touch-up and pricing policy

I understand the studio's pricing and that touch-up rates apply only to existing Narmela PMU Studio clients for work originally performed at the studio. I understand the booking deposit I paid (standard $50) is applied to my service total and is subject to the studio's booking policy.

9. Release

I confirm that I am at least 18 years of age, of sound mind, and not under the influence of alcohol or drugs. I understand I can ask questions at any time before my procedure begins — by phone, by message, or in person at my appointment — and that nothing starts until I am satisfied with the answers. If I have questions now, I will contact the studio at Narmelam@gmail.com or 647-865-9704 before my appointment. I voluntarily consent to the procedure and release Narmela PMU Studio and its artist from liability for known and disclosed risks inherent to the procedure when performed with reasonable professional care.

I have read and understood every section of this consent form. *My medical and intake information is complete and accurate. *I agree to follow all pre-care and aftercare instructions provided. *I understand results vary by individual and are not guaranteed. *(Optional) I allow my before/after photos to be used in the studio portfolio and social media. They may show my face and I may be recognisable; my name is never published.

Signature — type your full legal name

Typing your name here acts as your electronic signature, dated automatically on submission.