New Client Consultation Form

Lash & Brow Policies/Consents I GLO Beauty Bar, LLC

*Form is to be completed prior to appointment
Todays Date*

MonthDayYear
Full Name*

First NameLast Name
Date of Birth. (person who has appt.):*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
GLO Beauty Bar, LLC POLICIES
RESCHEDULING POLICY:

We understand that unexpected events happen, but in order to be fair to all clients, our rescheduling policy is strictly enforced. If your reservation will not work for any reason, please call us at 614-880-8222 or re-book online at least 24 hours in advance. If a notice is not given in this timeframe a 50% of total booked service(s) will apply and be charged to the card on file.

NO SHOW/CANCELLATION POLICY:

Should you forget or choose to forgo your appointment for whatever reason, you will be considered a “no-show.” No Show appointments without a 24 hr. notice will be charged 50% of service fee to card on file. After 1 no show, a clients may be required to pay for services in full prior to booking. We reserve the right to charge this fee up to three weeks after your appointment date.

LATE ARRIVAL POLICY:

If you are 15 or more minutes late for your appointment, the appointment may be cancelled and rescheduled (with a 50% of total booked service(s) charge to card on file) OR you may choose to continue your appointment with services modified to fit appointment time, thus lessening the effectiveness of your experience. Please note: You will still be charged the full fee for the appointment even if services are modifed. We recommend calling or texting if you know you’re going to be late so we can let you know if we can still fit you in.

SICK POLICY:

We ask that if you have a fever or feel unwell, that you contact us so we may reschedule your appointment. Please do not arrive to your appointment showing symptoms of being sick. Temperatures will be taken prior to your appt. to ensure the safety of our staff.

CHILDREN, TEEN & YOUNG ADULT POLICY:

To ensure a peaceful and relaxing environment and for the safety of all, children are not permitted in the studio unless they are receiving the service.
Young adults 14-16 must be supervised by parent or guardian while participating in Spa facials. We do not accept children under 14 at this time for services.
I understand and agree to GLO Beauty Bar, LLC's Policies
In order to provide you with the best possible care, we occasionally send convenient emails or SMS/MMS mobile messages from 614-880-8222 (or from our booking app) to our clients about their skincare, as well as services, discounts and products we offer. Depending upon your phone coverage, text fees may apply. You may opt out at any time.*

I understand and agree to receive occasional email / mobile SMS/MMS messages from GLO Beauty Bar, LLC
Contraindications for Lash Lift and/or Tint
Please check all that apply*

Allergies to adhesive tape, fumes, eye remover or tintsDry eye syndromeSjorgens SyndromCurrently having chemoOcular RosaceaEye Infection or eye diseaseBell's PalsyInflammation at treatment areaRecent eye SurgeryAllergies to bonding agents, glue or adhesivesBlepharitisContact Lenses (ok if not wearing at time of procedure)Eye Cysts, Styes, or HordeolaSkin trauma, cuts, burns, swelling etc. in treatment areaWeak LashesSkin disorders in the eye areaImpetigo or ConjunctivitisRecent eye, head or face surgery or scar tissue in treatment areaWatery eyesHypersensitive skin or eyesKeratitusAlopeciaTrichotillomaniaDry Eye Syndrome (Please provide medical clearance from your doctor)Glaucoma (Please provide medical clearance from your doctor)Post Chemo (Please provide medical clearance from your doctor)None of the Above
Contraindications for Brow Lamination/Tint
Please check all that apply*

PsoriasisEczemaAlopeciaCurrently having chemoSun BurnUltra sensitive skin or hypersensitive eyesWounds or lesions in the treatment areaPrevious reaction to a brow lamination or tintDermatitusActive Herpes infection near treatment areaSkin trauma, cuts, burns, swelling etc. in treatment areaImpetigo or ConjunctivitisWeak or damaged brow hairRecent eye, head or face surgery or scar tissue in treatment areaTrichotillomaniaAny disease/disorder that causes twitching or erratic movementsBrow Henna within last 48 hoursSteroid or cortisone creams recentlyRetinols, AHA, BHA or Vit A products in the last 48 hoursClaustraphobiaPregnant or breast feedingNone of the above
IMPORTANT INFORMATION
Do you have allergies, Please specify*
Have you had the following procedures*

Brow LaminationBrow TintBrow HennaEyelash LiftEyelash TintMicroblading or shadingBotoxNone of the above
If yes, what was the approx date?*
If applicable, have you had any adverse reactions to the list above? Please explain*
If having a lash lift eyes need to be closed for up to an hour, do you understand?*

Yes, I agree
I agree to not wear contacts (tint can get trapped under)*

Yes, I agree
CONSENTS + AFTERCARE

Appointment may or may not include all treatments
- I agree to have one or more of the follwing procederes applied to my natural lashes/brows or retouched: Brow lamination, Eyelash Tint, Brow Tint, Eyelash Lift. By signing this agreement, I consent to one or more of these procedures by my technician.
- I agree I do not have any of the contraindications listed above.
- I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash/brow tint.
- I understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. Other symptoms may include: mild tingling, slight redness due to brushing the hairs, slight warmth in the area. I agree that if I experience any of these medical conditions with my brows/lashes that I will contact my technician and consult a physician at my own expense.
- I understand that even though my technician perms or tints the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care.
- I understand and agree to the pre and post aftercare instructions provided by my technician for the use and care of my permed and/or tinted eyelashes/brows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told.
  
  AFTERCARE INSTRUCTIONS:
- No water can come in contact with the treatment area for 24 hours after the application
- Avoid shampoo, make-up, un-approved conditioners, un-approved makeup removers, creams, mascara, eye serums on lash/eye area for 24 hours
- Use a brow conditioner between treatments to maintain the health of the natural brow hairs.
- Avoid excess hot water or steam for the first 24 hours
- Do not rub or play with your eyes, lashes or brows
I understand and agree to the sections above
CLIENT SIGNATURE
I am over 18 years of age (or have a parent with me that consents to this service) and consent to the agreement and to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the products.

This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use.

There are no guarantees for length of time the lashes or brows will stay permed or tinted. I understand the aftercare instructions and will do my part to maintain my eyelashes and brows. I understand that there are many factors that may affect the life of the procedure such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them.
I understand + agree

YES
By signing below, I acknowledge that I have read and understood the above information, answered truthfully, and given an accurate account of my medical history, or that of my minor child's. I have agreed to follow GLO's recommendations and give my consent to be treated for Brow Lamination, Brow Tint, Eyelash Tint and/or Eyelash lift. This consent form is valid for all future Brow Lamination, Brow Tint, Eyelash Lift and/or Eyelash Tint treatments. I agree to alert the staff if there are any future changes to my (or my child's) medical history.

If I am signing this consent on behalf of my minor child, I agree I am the parent/legal guardian of the child named above. I have read the above information and give permission for my child to receive a facial treatment from GLO Beauty Bar.
Signature of adult:*

Clear
Date

MonthDayYear
Date
MEDIA CONSENT
I give GLO Beauty Bar, LLC permission to aquire and use my photo, video, and/or voice. I agree that GLO Beauty Bar, LLC has complete ownership of said pictures, videos, etc., and may edit, alter, copy, exhibit, publish, or distribute them for advertising, educational and marketing needs. These uses include, but are not limited to websites, social media, before and after photos, publications, advertisements, promotional, educational materials or for any other lawful purpose in any medium now known or later developed.

I acknowledge that I will not receive any compensation, etc. for the use of such pictures, etc., and hereby release GLO Beauty Bar, LLC from any and all claims, which arise out of such use. I understand that GLO Beauty Bar, LLC cannot control unauthorized use of images, video or audio by persons not associated with GLO Beauty Bar, LLC once material has been published. I hereby forever waive any right to inspect or approve any publication by GLO Beauty Bar.
I understand and agree to GLO Beauty Bar, LLC's Media Consent Form & use of my photo/vidsPlease do not share or take photos of me
If you would like us to tag you, please enter your social media name:
Should be Empty:

Lash & Brow Policies/Consents I GLO Beauty Bar, LLC

GLO Beauty Bar, LLC POLICIES

Contraindications for Lash Lift and/or Tint

Contraindications for Brow Lamination/Tint

IMPORTANT INFORMATION

CONSENTS + AFTERCARE

CLIENT SIGNATURE

MEDIA CONSENT