Waxing Consent Form

CLIENT GENERAL INFORMATION

Brows By Ash
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Brows by Ash may ask clients for their permission to take photos before/after/during the service. Do you consent to photos being used for social media/educational services?*

YesNo
WAXING CONSENT FORM

Brows by Ash
Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

YesNo
Have you used any products including retinol or Retin-A, tretinoin or vitamin A within the past 7 days?

YesNo
Have you used Accutane within the past year?

YesNo
Are you using any skin thinning products/drugs?

YesNo
Do you use tanning beds and/or are exposed to the sun on a regular basis?

YesNo
Are you currently taking any medications? If so, please list.
Have you been treated for cancer? If yes, when and what types of therapies were used?
Please list any illness/conditions which you are currently being treated for by a medical professional.
Do you have any allergies? If so, please list.
If tinting: Have you ever used brow tint/hair dye before?

YesNo
If tinting: Have you ever had an adverse reaction to the brow tint/hair dye?

YesNo
If tinting: I understand that tinting lashes or brows has some inherent risk of irritation to the orbital eye including the eye itself, and could result in stinging or burning, blurry vision and potentially should the tint enter the eye.
Initials
Please note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician. I give permission to my Esthetician to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.
Signature

Clear
Date

MonthDayYear
Date
Name

First NameLast Name
Parent/Guardian Name of Minor (If applicable)

First NameLast Name
BROW LAMINATION & LASH LIFT CONSENT FORM

Brows By Ash
I am informing my technician of any of the following contraindicated conditions for the brow lamination.

Currently undergoing chemotherapyCurrently pregnant/breastfeedingAlopeciaPsoriasisEczemaSunburnUltra sensitive skinWounds in the treatment areaCurrent/recent use of Retinol/Renova/Accutane (within past 6 months)Current/recent use of AHAs/Glycolic Acid
I am informing my technician of any of the following contraindicated conditions for the lash lift.

Dry Eye SyndromeSjorgen’s SyndromeOcular RosaceaCurrent allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives, and removers that could cause my eyes to water and blink in excessAllergies to adhesive tape, fumes or eye makeup remover
Lash Lift Clients: I consent to having my eyes closed and covered for the duration of the 45-60 minute procedure

YesNo
Lash Lift Clients: I wear contacts

YesNo
Lash Lift Clients: I understand that tinting the lashes has some inherent risk of irritation to the orbital eye including the eye itself, and could result in stinging or burning, blurry vision and potentially should the tint enter into the eye.

YesNo
I agree to have an eyelash lift, brow lamination and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm, brow lamination or eyelash tint by my technician.
I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash tint.
I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.
I understand that some mild but normal symptoms may occur with the brow lamination depending on the sensitivity of my skin during the procedure and will subside in 24 hours. These 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 lashes that I will contact my technician and consult a physician at my own expense.
I understand that even though my technician perms the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/brows or require a physician’s follow-up care.

I realise and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told. I agree to the following Post- Lash Lift/Eyelash Tint: No water can come in contact with the eye/brow area for 24 hours after the application, avoid using oil containing sunscreens, moisturisers and cleansers on the lashes. I understand that there is no guarantee on the length of time that the lamination or lash lift will last.

By signing below, I verify that I have read and understand the above statements and agree to them.
Signature

Clear
Should be Empty:

CLIENT GENERAL INFORMATION

WAXING CONSENT FORM

BROW LAMINATION & LASH LIFT CONSENT FORM