Name
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First Name
Last Name
E-mail Address:
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example@example.com
Date Of Birth
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-
Month
-
Day
Year
Date
Phone Number:
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READ SELECTIONS BELOW CAREFULLY. (SELECT ALL THAT APPLY TODAY AND FOR ANY SERVICES THAT YOU MAY WANT IN THE FUTURE
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TINTING EYEBROWS
LASH LIFT/TINT
LASH LIFT *NO TINT
LASH LIFT/TINT, BROW TINT, BROW WAX
LASH LIFT/TINT, BROW WAX/TINT/LAMINATION
BROW LAMINATION
BROW WAX
BROW TINT
I understand that lash and brow services are generally safe when performed as directed, and most clients can resume normal activities immediately following treatment.
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Please initial
I understand that lash lifts, lash tinting, brow tinting, and brow laminations may cause temporary irritation, redness, watering of the eyes, sensitivity, or an allergic reaction in some individuals. Every effort will be made to ensure my comfort and safety during treatment.
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Please initial
I understand that if a product accidentally enters my eye, the area will be rinsed immediately and additional care may be recommended if needed.
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Please initial
I understand that temporary redness, sensitivity, itching, or irritation may occur after treatment.
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Please initial
I understand that tint may temporarily stain the skin and will fade naturally.
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Please initial
I understand that results vary and exact color results cannot be guaranteed.
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Please initial
I understand that lash and brow results are temporary and will gradually fade over time.
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Please initial
Have you previously received lash or brow tinting, lifting, or lamination services?
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Yes
No
If yes, approximately when?
Were you happy with the results?
Have you ever experienced an allergic reaction or sensitivity to hair color, lash tint, brow tint, lash lift, or brow lamination products?
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Do you wear contact lenses?(Contact lenses must be removed prior to a lash lift service.)
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YES (CONTACTS MUST BE REMOVED FOR LASH LIFT TREATMENT)
NO
ARE YOU PREGNANT OR NURSING?
YES
NO
Have you had eye surgery within the past 6 months?
Lash services may need to be postponed until approved by your physician.
Are your currently using Retin-A, Tretinoin, Retinol, or exfoliating products around the eye area? *brow waxing may not be recommended if these products are being used around the brow area.
YES
NO
Do you currently have any eye condition, infection, irritation, or injury?
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Yes
No
Do you have any known latex or rubber allergies?
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Yes
No
Please list any medications you are currently taking:
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Do you have any known allergies or sensitivities to cosmetic products, fragrances, hair color, or lash/brow treatment ingredients?
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Yes
No
I give permission for Viso Bello Spa to use before-and-after photos for educational and marketing purposes. My identity will not be disclosed without additional consent.
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PLEASE INITIAL
I understand a patch test may be recommended before treatment. By signing below, I choose to proceed without a patch test if one has not been performed.
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Name
*
First Name
Last Name
Signature
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Date
*
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Month
/
Day
Year
Date
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