Brow Lamination Consent Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Service

Brow LaminationBrow Tint

Have you had reaction to any previous brow lamination or lash lift?

YesNo

Do you have very sensitive skin?

YesNo

Have you have microblading or any semi-permanent brow procedure in the last 2 months?

YesNo

Are you taking any skin medications (i.e. accutane)?

YesNo

Are you currently taking any skin routine such as applying AHA, BHA, Retinol (ex. anti-aging skin prosecutors)?

YesNo

Are you pregnant or currently breastfeeding?

YesNo

Do you have a wound, scar tissue, or pimple in the area to be treated?

YesNo

Please note that this procedure can have certain side effects such as 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 eyebrow lamination and/or tint 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: avoiding excessive sun exposure, sweating, tanning, saunas, swimming pools, and certain facial treatments; 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.

Date

Signature