BROW LAMINATION AND TINT

BROW LAMINATION & TINT

CONSENT FORM
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

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CityState / Province

Postal / Zip Code
MEDICAL/HISTORY DATA
RashesPsoriasisDiabetesEczemaHistory of skin disease or skin sensitivityOther
YesNo
I understand the patch test does not guarantee that an allergic reaction will not occur .*
Have you had botox in your forehead within 4 weeks of the appointment date?
Are you currently taking any medications? If yes, please list them below:
AUTHORIZATION

I give permission to Sophia Cooper to perform brow lamination and/or tint services and will hold her harmless from any liability that may result from this treatment. I understand that brow lamination is a 2 step chemical processing system that first softens eyebrow hair bonds in order for the eyebrow hairs to be manipulated into a new shape. Secondly a chemical treatment is used to set the desired shape of the eyebrow hair. I understand that precautions are taken on processing times and results may vary. Meaning, everyones brows are different and take to lamination products differently. I understand that brow tinting is a semi-permanent dye that darkens the eyebrow hair color to sculpt and define the brows. Although, my aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible I undertsnand brow lamination and tinting does have certain side effects and risks such as burning, itching, redness, tenderness, etc. If I have any concerns I will address them with my aesthetician. I have not used any Alpha Hydroxy Acid (AHA), Glycolic products, or sun bathed in the past 48-72 hours nor am I using Retin-A, Accutane (An oral form of Retin-A), Antibiotics, I am not using any other skin thinning products and/or drugs that would increase brow lamination and tinting. I do not have Conjunctivitis, Psoriasis/Eczema or any cut/abrasions/inflammation that would be a contradiction of brow lamination.
I have read and understand the contents of each paragraph above. I acknowledge this is a contract and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent to this procedure(s), I was of sound mind and capable of making independent decisions for myself.
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Date*

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BROW LAMINATION & TINT

MEDICAL/HISTORY DATA

AUTHORIZATION