Acknowledgement and Waiver I hereby agree to have this treatment. I am aware that products used in facials and homecare may contain tree nuts, sulfur, dairy, and gluten. I acknowledge that the esthetician at The Beauty Room Knox may use products that contain these ingredients or are manufactured in a plant with these ingredients. I am aware that even with natural ingredients there is a remote chance of an allergic reaction and there is a possibility of an adverse reaction to product used in facials. Please inform your esthetican before treatment if severly allergic, as this may make you unable to receive the service.  I am also aware that certain services should not be performed with certain medical conditions or prescriptions. I have disclosed all my known medical conditions, skin conditions, allergies, medications and answered all questions honestly on the above form and agree to update The Beauty Room Knox as to any changes. It is my responsibiliy to disclose all medical, medicinal, and skin history, as Beauty by Robynne will not be responsible to reactions caused by undisclosed medical history. I acknowledge the esthetician at The Beauty Room Knox do not provide medical advice and I accept full responsibility to seek out advice before receiving any services or products from The Beauty Room Knox. I hereby release, discharge and waive all claims against The Beauty Room Knox and each of their employees, and representatives or any person(s) performing services or applying any products at The Beauty Room Knox, including from liability and responsibility for any and all illness, injuries, damages, claims, rights and causes of action of any kind or nature, that may occur during or arising out of any services or products received on this and any future dates. I expressly assume and accept the risk for any injuries sustained.

Acknowledgement and Waiver I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician. 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 esthetician 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 have read this entire document and agree to its terms. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Emilee Hickman responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. By signing below, I verify that I have read and understand the above statements and agree to them.

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I confirm I have read the above information and if I have any concerns, I will address these with Emilee Hickman. I give permission to my esthetcian to perform the waxing procedure we have discussed and will hold her harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand that Emilee Hickman will take every precaution to minimize or eliminate negative reactions as much as possible. I understand that I should keep the treated area free of products for 24 hours post-treatment. I am willing to follow recommendations made by Emilee Hickman for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the my therapist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.Acknowledgement and Waiver I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician. 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 esthetician 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, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Emilee Hickman responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

 I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Emilee Hickman responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.I agree to have an eyelash lift, brow lamination and/or tint applied to my natural eyelashes/eyebrows and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm, brow lamination or tint by my esthetician. I understand there are risks associated with having an eyelash perm, brow lamination and/or 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 lamiation 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 esthetician 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 understand and agree to the care instructions provided by my esthetician for the use and care of my permed and/or tinted eyelashes/eyebrows. 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. I agree to the following Post- Lash Lift: No water can come in contact with the eye area for 24 hours after the application. Avoid makeup such as mascara, eyeliner or brow pencil for the first 24 hours. Avoid using oil containing sunscreens, moisturizers and cleansers on lashes for the first 24 hours. Acknowledgement and Waiver I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician. 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 esthetician 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/brows will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes/eyebrows. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Emilee Hickman responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.By signing below, I verify that I have read and understand the above statements and agree to them.

A no call, no show will be charged 100%

A 24 hour cancellation or reschedule will be charged 50%.

If you are more than 15 minutes late to your appointment it will be cancelled and you will be charged 50%

I realize emergencies and life happens and they will be considered. That being said please respect my time and others as we respect yours.

 

By signing bellow I am stating that I fully understand and am aware of the cancellation/reschedule policies.