BROW/LASH TINTING FORM

Name

First NameLast Name

Please choose any previous discomfort, stinging, allergies/ adverse reactions:

If you responded yes to any of these please specify/ add any relevant information:

Have you had eyelash or brow tinting, eyelash perming, eyelash extensions, or semi permanent mascara applied previously?

If yes, did you experience any reaction to these treatments?

If yes, please specify

Agreement: I request and consent to these procedures being carried out without undergoing a sensitivity patch test. The sensitivity test, which if conducted, may indicate my sensitivity/ allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services.

Signature

Date