Hair Simulation Makeup for Bald Spots to Conceal African American Hair Loss

1. Are you on any medications? If so, e-mail me a list of medication.

2. Are you using blood thinners, aspirin, steroids, acutane...?

3. Have you had a cold sore in the past? (If so we suggest using Valtrex 1 week before and one week after procedure)

4. Have you had hair transplant surgery or a scar revisions?

5. Are you allergic to any food or medication? This includes antibiotics ointments and Latex . If so, e-mail me the details

6. Do you have a blood diseases?

7. Are you using any hair chemicals or dyes? If so, do not use for 2 weeks after procedure. Email what dyes are being used, ie Bejing, black ice…

8. What procedures are you interested in?

9. May I use your Photo?

10. I understand that I have read the nature of my Treatment, and the risks. I consent to this treatment and that I am of sound mind and body, I hereby release Artistic Hair Simulation^sm and its artists of liability.

11. I have read and understand the aftercare requirements ie Do not put any chemicals on your head for 10 days, although you can rinse will cool water. Do not scrub your head for 10 days. Do not use hair makeup for 10 days. The tattoo will lighten over a 2 week period. Use the ointment that is given to lubricate your scalp. Notify us asap if any irritation starts. Use sterile blades when cutting your hair.

12. I am over the age of 18.

13. If I have any type of allergic reaction I will contact my doctor ASAP, and notify Artistic Hair Simulation^sm

14. Are you pregnant?

15. What Type of Payment form will you be using?

Note: We do not accept credit/debit cards

16. Do you have "Mitral Valve Prolapse." If so you will need to inform your Doctor and get proper medication.

17. Do you plan on having laser done on your face. If so have your doctor cover the tattooed area.

18. How did you hear about me?

19. I understand not to put anything on tattooed area for at least 10 days and to follow all aftercare instructions

20. I understand to only use the oil or ointment that is given and nothing else, and use sterile blades to cut my hair, and that if I use anything else I may have complications (i.e.loss of colour, infection…)

21. I will e-mail phone number and person to contact in case of an emergency.

		Contact Name:
		Contact Phone:

22. Have you had other tattoo?

23. Do you Keloid?

24. I understand that there is a risk of infection , and that this is a tattoo and considered permanent, although it may fade over time. All aftercare must be followed, and it may take more than one procedure to get desired results. Areas that have a scar, do not hold ink as well, and may require additional sessions. If hair loss continues, fill ins may be needed. I understand that my hair must be kept at a specific length, in order for the Tattoo to look natural. I understand that i must notify Artistic Hair Simulation Artist, ASAP, if an irritation occurs, and stay in contact, until the issue is resolved

25. I understand that several touch ups may be required and that all skin takes the ink and color different. Color needs to be checked at least once a year or two. I also understand that there are no refunds.

26. I understand that By signing I am confirming that I have correctly competed the client history form and have disclosed all information required.