Brow Lamination Consent Form
Name
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First Name
Last Name
Date
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Month
-
Day
Year
Date
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Questionnaire
I am requesting and consent to have Riri Brow Bar perform a brow lamination and/or brow stain on my eyebrows ___________ undergoing a sensitivity patch test (Please note patch test must have been previously booked 48 hours before service)
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With
Without
Are you currently pregnant? (If you are pregnant you do not qualify for this service)
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Yes
No
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Precautions
I understand that in the following statements the term "Riri Brow Bar" also refers to the person performing the procedure Rubi Trejo
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I agree
I agree to hold to hold Riri Brow Bar harmless if I decline a patch test
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I agree
I understand the risks associated with the brow lamination/stain services
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I agree
I understand that with this procedure I may experience skin or eye irritation, eye pain, itching, discomfort or swelling
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I agree
I understand that my skin and eyebrows may react to this service and I may experience over pigmentation, under pigmentation, residual staining of the skin, or damage to the natural eyebrows. I agree to contact Riri Brow Bar if I experience any of these issues and consult a physician at my own expense
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I agree
I agree to follow the care instructions provided to me by Riri Brow Bar for the care of my laminated brows
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I agree
I understand that there is no guarantee as to how long my eyebrows will remain stained and/or laminated
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I agree
I understand I may not wear contact lenses during this procedure, they must be removed prior to starting service
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I agree
I understand I must not wet, steam or apply any makeup on the brow area for at least 24 hours after the service is performed
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I agree
I understand that in order for Riri Brow Bar to preform a brow lamination and/or staining procedure, I will be required to keep my eyes closed for the duration of 45-60 minutes. I understand that if I sustain an injury due to opening my eyes during the treatment, I will hold Riri Brow Bar harmless
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I agree
I understand that I will be lying flat on my back for the duration of the service, if I have a medical condition that might be aggravated by this I will inform Riri Brow Bar of this condition and furthermore will not be able to receive a brow lamination and/or stain performed
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I agree
This agreement will remain in effect for the duration of the procedure and for all future reoccuring procedures of the same nature
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I agree
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Signature
I have read and agree with the above information. I have given an accurate account of all of the questions, if I have any questions or concerns I will address these with my service provider. I understand that Riri Brow Bar will take precaution to minimize and/or eliminate unwanted reactions. I give permission to my service provider to perform the brow lamination and/or stain procedure and I will hold her harmless from any liability that may result from this treatment.
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Submit
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