NEW CLIENT Information & Treatment Consent

  • Client Information

  • Format: (000) 000-0000.

  • Please answer the following to the best of your ability. Although the information may feel unnecessary, some conditions or medications may affect the results of your treatment or may be a contraindication to your service.

  • Do you have any allergies?*
  • Are you pregnant or nursing?*
  • Do you participate in rigorous activity/exercise?*
  • Are you currently on Accutane? Have you been on Accutane in the last 6-12 months? (Accutane use is a contraindication for many services, especially waxing and exfoliation - if you are currently taking Accutane, we can discuss your service options)*
  • Have you used Retin-A, retinol, AHA or topical exfoliating products in the last 5 days?*
  • Have you received Botox or dermal fillers in the last 14 days?*
  • Please choose all that apply to you:
  • Have you had any recent surgery - in the last 12 months?*

  • Services

    Please select the service(s) you have booked
  • Lashes
  • Have you ever had lash extensions applied before?
  • Have you ever had a reaction to lash extensions?
  • Have you ever had a reaction to eye pads/medical tape?
  • Do you have a tendency to rub, pick or pull at your eyelashes?
  • Have you ever had a lash lift & tint?
  • Have you ever had a reaction to a lash lift?
  • Have you ever had a reaction to lash/brow tint?
  • Have you ever had a reaction to hair color or perm solution?
  • Are you currently using any lash growth serums/products?
  • Do you wear contact lenses? It is recommended to remove contact lenses for your treatment.
  • Have you ever had a brow lamination before?
  • Have you ever had a reaction to perm solution or hair color?
  • Are you currently using any brow growth serums?
  • Have you ever had a spray tan?
  • Do you have any recent tattoos or piercings?
  • Do you currently have a sunburn, or have you had a sunburn in the past 14 days? (this may affect the result of the spray tan)
  • What areas of concern do you have regarding your skin?

  • Treatment & Service Consent

  • I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.

  • I have been informed of possible benefits, risks, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

    I understand how important it is to follow all instructions given to me for post-treatment care. 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 esthetician immediately.

    I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the esthetician 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. 

  • Should be Empty: