Brow Lamination Waiver Form

First & Last Name:

Email

example@example.com

MEDICAL HISTORY

Is this your first time receiving brow lamination services? (If yes, skip the next question.)

Have you had reaction to pervious brow lamination?

Did you have microblading or any semi-permanent brow proedure in the last 2 months?

Do you have very sensitive skin?

Are you taking any skin medication or any acne medications (i.e. accutane, retinol)?

Are you pregnant or currently breastfeeding?

Do you have any of the following conditions? (Please check all that apply)

By checking the boxes, you confirm that you agree with the following statements.

By signing below, I agree to the following:

I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform the
technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician and the salon for any injury or damages incurred due to any misrepresentation of my
health. This agreement will remain in effect for this procedure and all future follow-ups conducted by the technician. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I am over 18
years of age and consent to the agreement and to the brow lamination procedure.

Date

Signature