Brow_Lamination_Consent_Forms

  • Brow Lamination Intake Form

  • General Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Would you like to be added to our email list for specials and discounts?

  • Brow History

  • Have you ever had your brows laminated?*
  • If yes, have you ever had an adverse reaction?*
  • Have you ever had an allergic reaction to hair dye?*
  • Have you ever had an allergic reaction to a perm?*
  • Are your eyebrows microbladed?*
  • Have you ever had an allergic reaction to a perm?*

  • Medical History

  • Do you have any of the following conditions? (Please check all that apply)
  • Are you or could you be pregnant?*
  • Do you have, or are you being treated for any kind of eye injury?*
  • Do you have any allergies?*
  • Are you currently taking any medications or supplements?*
  • Are you currently using Retinol, Accutane, AHAs, or BHAs?*

  • Brow Lamination Consent Form

  • Although every precaution will be taken to ensure my safety and wellbeing before. during and after the brow lamination process, I am aware of the following information and possible risks. Please initial:*
    • Alopecia
    • Conjunctivitis
    • Currently taking blood thinners. brow
      growth serum, retinal, Accutane, or
      AHAS or BHAs
    • Eczema
    • Pregnant/breastfeeding
    • Recent eye surgery
    • Recent microblading
    • Retinal
    • Sensitive skin
    • Scar tissue in treatment area
    • Sunburn
    • Psoriasis

  • Consents

  • I hereby grant and authorize Lancaster’s Luxe Lashes the right to take, edit, alter, copy, exhibit. publish, distribute and make use of any and all pictures. video, and/or audio is taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social networking sites, and other print or digital communications without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or later discovered. I waive the right to inspect or approve the finished product wherein my likeness appears, including a written or electronic copy. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I hereby hold harmless and release Lancaster’s Luxe Lashes from all liability, petitions. and causes of action which I. my heirs. representatives. executors. or any other persons may make while acting on my behalf or on behalf of my estate.

  • This agreement will remain in effect for this procedure and all future follow-ups conducted by the technician. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to brow lamination procedure.

     

    By signing below I knowingly and willingly consent to release any and all liability for the unintentional exposure or harm due to COVID- I9.

     

    By signing below, I agree to the following:
    I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician and the salon for any injury or damages incurred due to any misrepresentation of my health

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