HENNA BROWS STATEMENT OF CONSENT

HENNA BROWS CONSENT FORM

Please read the following carefully and initial on each line.

Signature*   I will advise my technician now if I have any of the following:

Sickle Cell Anemia
Psoriasis
Acne (breakouts)
Infection such as pink eye
Open wounds in brow area
Cold sores
Allergies to plants/plant-based products
Known allergy to hair dye


Signature*   I have been advised that a patch test prior to the procedure is available upon request. If I wish to exercise this option, I will inform my technician now (please allow 48 hours to pass after patch test before scheduling appointment). Otherwise, I waive this option.
Signature*    I am aware that allergies can develop at any time.
Signature*   I am aware that results may vary per client. If I would like further details, I will ask my technician now.

I agree to the following pre-appointment instructions:*

For best results exfoliate brows the night before your service.Avoid lotions/creams the day of your appointment. All Henna brows include consultation, brow shaping, brow mapping and clean up/wax.Please remember to come to your appointment eye make up free, we have eyewash brushes available for sale via our online booking.

If you have any allergies or skin conditions not previously disclosed, please do so now: (Write none, if there isn't any)*

We would like your permission to use these photos for advertising. For example: portfolios, online and print ads, etc. Your consent is necessary regarding this. Please check next to the line and indicate with your signature if you would like your photos used or not used in advertising.*

Yes, feel free to use them.No, please do not use them

I am over 18 years of age and consent to the agreement and to treatment.

I release my technician or salon 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.

I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in the procedure(s). I have had the opportunity to ask questions, and all of my questions have been answered, acknowledge that I have reviewed and approved the material given to me, and I authorize Elevate Lash Lounge Inc. to perform the Henna Brows procedure desired today.

Date of Birth*

Date

Client's Name*

First NameLast Name

Social Media Handle*

I acknowledge that Elevate Lash Lounge is strictly open by appointment only.I agree to come ON TIME but NOT EARLY to my appointment to give time for the staff to properly prepare for my appointment & out of consideration to previously booked clients.

By signing below, I verify that I have read and understand the above statements and agree to them. (An insurance release form may also need to be signed that provides coverage for this procedure.)

Client Signature*

Date*

Date