understand and acknowledge that I am of the full age of 18 years or older. If below 18 years of age a parent or guardian must also sign this form. I confirm that I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to agree to the terms of this agreeement or safely commence the procedures herein. This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician conducting business at GLOW SKIN LASH BROW. I understand that this agreement is binding and that I have read and fully understand all information.
I fully understand and accept the procedure and risks associated with brow lamination and/ or tint where my eyebrow hairs will be semi-permanently restructured and styled and or tinted. I further hereby save harmless and indemnify GLOW SKIN LASH BROW for any damages whatsoever resulting from me not complying with the request GLOW SKIN LASH BROW has stated herein.
I understand and accept that it is my responsibility to remain still in a flat position throughout the application otherwise advised. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that GLOW SKIN LASH BROW will not be able to have the procedure performed on my eyebrows.
If at any time I am uncomfortable with the brow lamination and/or tint procedure, I will inform the esthetician and the estheticiain will gladly rectify the problem, including ending the session if I (or the esthetician) wish. If the esthetician is uncomfortable performing the brow lamination and/or tint on me, the esthetician will discuss their concerns with me and may end the session if necessary. It has been represented to me that no guarantees, warranties, promises, commitments or other statement as to the results of this service have been made, and I acknowledge that I have received no particular representation or guarantees, and I am consenting to the procedure at my own risk.
I have revealed or disclosed conditions and circumstances regarding my health and health history, medication being taken and any past reactions to products used or medication taken. I understand, additional conditions could occur to be discovered during or after the procedure, which could affect my ability to tolerate the procedure. I confirm that I do not have any medical, skin or hair conditions that may interfere with the procedure, application mentioned herein.
I confirm I do not have any of the following skin conditions. If I have any of the following skin conditions, I understand I will not be suitable for the brow lamination and/or tint procedure.
• Ultra-Sensitive Skin
• Wounds or Scar Tissue in the treatment area
• Pimple in the treatment area
I confirm, I have not had any kind of permanent makeup procedure on my Brows for at least 8 weeks.
I confirm, I have not had any skin treatments on my face for at least 4 weeks and have not been on any medication that can affect the skin (such as Accutane) for at least 6 months.
I confirm, I am not pregnant or are breastfeeding.
I understand and accept that Brow Lamination is an Alkaline based perm, so it is very strong. It is not suitable for clients with chemically damaged hair or extremely curly hair, as it can damage it further or cause unpredictable results. If the esthetician finds or determines my brow hairs are damaged or is too curly, the esthetician may decide not to proceed with the service.
I understand and accept that some mild but normal symptoms may occur depending on the sensitivity of my skin during the procedure and will subside within 24 hours. These symptoms include:
(a) Mild tingling
(b) Slight redness due to brushing brow hairs back and forth
(c) Slightly warm in the area
I acknowledge that I have been advised by GLOW SKIN LASH BROW of the following potential health/medical risks associated with receiving brow lamination and/or tint and still wish to proceed with the procedures mentioned herein:
(a) Allergic reaction symptoms: itching, severe burning, skin flaking or peeling, inflammation, blisters
I understand individual responses to product used for brow lamination and tint may vary - should a reaction occur, it is my responsibility to seek medical attention at my own expense.
I will advise the estheticiain of any discomfort, irritation, and/or discomfort immediately.
I understand it is my responsibility to follow the aftercare instructions for best results
I understand in order to maintain the effects of brow lamination and/or tint, the procedure needs to be re-done every 5-8 weeks for maintenance.
I understand that brows may be come unruly if touch ups are not done.
I understand brow lamination will make styling the brows easier, but will not eliminate the need for styling. Brushing and/or use of a styling gel may still be required.
2. WAIVER, RELEASE OF LIABILITY AND INDEMNITY
I, inconsideration of Alison Wilcox and GLOW SKIN LASH BROW completing the procedure(s) mentioned below, hereby release and further agree not to make any claim or demand, or commence legal action against GLOW SKIN LASH BROW for damages, compensation, loss or any relief whatsoever in respect of any cause or matter relating to the procedure(s). I further agree that this Agreement shall operate conclusively as an estoppel in the event any such claim, action or proceeding and may be pleaded accordingly.
I accept full responsibility for and indemnify and hold GLOW SKIN LASH BROW, and any of its employees and/or contractors, harmless and without liability of any kind whatsoever for the responses to products used for brow lamination and tint may vary - GLOW SKIN LASH BROW and its employees will not be held responsponsible for any injury or damage that may occur due to brow lamination and tint.
I further agree to hold GLOW SKIN LASH BROW nameless and harmless from any and all damages. I release GLOW SKIN LASH BROW from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises after the procedure. I understand I am responsible for any medical treatment I may need to receive because of getting this procedure. I accept full responsibility for these and any other complications, which may arise or resulting of getting this procedure(s), which are to be performed at my request.
Having read the above, I acknowledge that all of procedures contemplated and consented to herein have been fully explained and I fully understand the nature, scope and potential risks of the procedure(s) I am consenting to being performed and accept full responsibility for any and all results of the said procedure.
I further acknowledge that any information provided by me to GLOW SKIN LASH BROW is being provided solely for the purpose of GLOW SKIN LASH BROW'S internal records and under no circumstances is it deemed to be given to GLOW SKIN LASH BROW for the purpose fo making or giving any medical advice, decisions, opinions, diagnosis, or representation to me or any other third party.