Brow Lamination + Brow Tinting

Name

First NameLast Name

Date of birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email

example@example.com

Todays date

Date

Have You Had A Brow Lamination + Tint or Henna Brow Before

YesNo

Do you have any allergies?

YesNo

Did you react to the product ?

YesNo

If you had a adverse reaction to a previous Lamination or Henna - Please explain

Although every precaution will be made to ensure your safety and well-being before, during and after your application, please be aware of the possible risks below. Please Initial:

I understand that the results vary from person to person

Initial

I understand that if I talk or move around during the procedure it can affect the outcome.

Initial

I understand I cannot get my Brows wet for 24hours after the procedure

Initial

I understand that over the course of 2 weeks, the henna or tint will gradually lighten and fade. A new appointment will be required to keep the new color. Most clients rebook 4 weeks apart. 8 weeks for Lamination.

Initial

What over the counter or prescription skin care products are you currently using?

Do you have Diabetes, Lupus, or any auto-immune disease? Yes/No? (If yes please describe)

Please list any medications you are taking, including over-the counter herbs, vitamins and supplements:

List any allergies you have (nuts):

Do you have asthma?

How did you hear about us?

Have you had just tinting before?

I have read the above information. If I have any concerns, I will address these with my tech. I give permission to my technation to perform the Henna/Lamination procedure we have discussed and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my Brow Technician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the Technician immediately.I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I had enough opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the Tech, whome signature appears below, 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.

Initial

I confirm (to the best of my knowledge) that the information I have provided is accurate and complete. I have not withheld any information that may be relevant to my treatment and/or the result thereof. I am aware that there are often inherent risks associated with skin care services including tinting procedures, and that the service I am about to receive could have unfavorable results including, but not limited to: irritation, burning, redness, dye on the skin etc.

Initial

By signing below, I further agree that I will not hold Stelletta Beauty or its affiliates responsible should there be any unfavorable outcome or result.

Initial

I release my technician/Stelletta Beauty from all liability associated with this procedure. Our company is not responsible for any technicians errors. I understand that I have been advised to follow the aftercare protocol from my technician after the service.

Initial

I allow Yem at Stelletta Beauty to take a before / after picture of my service - these photos may be used on our website, our Instagram or Facebook page etc.

Signature

Date

Any Questions:

Technician Signature