Eyebrow Lamination and Tint Client Consent Form

Eyebrow Lamination and Tint Client Consent Form

Cherry Bxmb Beauty
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date

MonthDayYear
Date
Referred by

First NameLast Name
Have you received an eyebrow lamination and/or tint service before?

YesNo
Do you wear makeup often?

YesNoOnly special occasion
Have you received a permanent cosmetics service before? Ex. Microblading, Lip blushing, permanent eyeliner.

YesNo
Please list any and all allergies.
Please list any and all medical conditions you may have that can potentially interfere with today’s service.
Please list any and all vitamins or supplements.
Have you used or currently taking Retina A, Accutane or any medically prescribed skincare?

YesNo
Please list any and all medication you are currently taking that may interfere with today’s service.
Are you currently pregnant?

YesNo
initial I understand that this procedure uses my natural eyebrows in a chemical process to lift/curl my eyebrows and to tint them.
initial I understand that some risks of this procedure may be, but not limited to skin redness and irritation.
initial I agree to disclose any allergies, conditions or other topics talked about in the client consent form my eyelash artist should be aware of.
initial I agree that by reading and signing this consent form, I release Cherry Bxmb Beauty and Salon H3 from any claims of damages of any nature.
initial I give Cherry Bxmb Beauty and Salon H3 permission to show my before and after pictures to potential clients.
blanks I give Cherry Bxmb Beauty and Salon H3 permission to post my before and after pictures to social media.
blanks I confirm and agree that I wish to engage the services of Cherry Bxmb Beauty and Salon H3 to apply an eyebrow lamination and/or tint.
initial Cancellation policy is fully understood.
blank I agree that I read, completed, and fully understood this entire consent form in it’s entirety and I have answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that could be caused by the application and/or removal process.
Should be Empty: