Addendum for Prior Old Cosmetic Tattoo


Addendum For Prior Old Cosmetic Tattoo

  1. Approximately when was your last procedure done? _________________________________
  2. Do you know what pigment brand was used? _________________________________
  3. Did you observe & sign off that you saw your needle being disposed of into a Sharp’s container? ____________________________
  4. Did you sign any consent and release forms? _________________________________
  5. Were before and after photos taken? ________________________________
  6. Were you given Pre and Post care instructions of your procedure? _____________________________
  7. Were you happy with your results when your procedure was done? __________   If not why?____________________
  8. Has your old cosmetic tattoo faded true on tone (color)? ___________________________
  9. Is there an undesirable color tone in your skin that you would like to have covered?_____________ If yes what undesirable color tone do you see in your skin?______________________________


  1. Please explain briefly why you are requesting another cosmetic tattoo procedure and what results you desire? ________________________________