• Waxing, Lash Lift, Brow Lamination, and/or Tint

    Consent Form
  • Format: (000) 000-0000.
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  • Lash Lift, Brow Lamination, and Tint Consent

  • I am informing my technician of any of the following contraindicated conditions for the lash lift.
  • I am informing my technician of any of the following contraindicated conditions for the brow lamination.
  • I consent to having my eyes closed and covered for the duration of the 60-90 minute lash lift procedure.
  • I wear contacts
  • I agree to have an eyelash lift, brow lamination and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm, brow lamination or eyelash tint by my technician.  I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.  I understand that some mild but normal symptoms may occur with the brow lamiation depending on the sensitivity of my skin during the procedure and will subside in 24 hours. These symptoms may include: mild tingling, slight redness due to brushing the hairs, slight warmth in the area. I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense. I understand that even though my technician perms the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/brows or require a physician’s follow-up care. I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes/eyebrows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told. I agree to the following Post- Lash Lift:. No heat or steam should come in contact with your lashes or brows. This includes heavy workouts, sauna, or long hot showers (facing the water). Avoid makeup such as mascara, eyeliner or brow pencil for the first 24 hours. Avoid using oil containing sunscreens, moisturizers and cleansers on lashes for the first 24 hours. Acknowledgement and Waiver I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them. 

  • Date
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  • Waxing Consent

  • Have you used any chemical exfoliants (AHA, BHA, Retinol, etc.) in the past 48-72 hours?*
  • Are you using any other skin thinning products and/or drugs?*
  • Are you exposed to the sun on a daily basis or are you considering spending more time in the sun soon?*
  • Do you use a tanning bed?*
  • Are you diabetic?*
  • Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. 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 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 have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, whose 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.

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  • Date
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  • Photo Release: I grant permission for Skin Health with Mel to take/use photos or videos taken during my service for social media purposes (e.g. Instagram, Facebook, website etc.).
  • Please read cancellation policy below:

  • Minor Policy: To maintain a safe and relaxing environment, minors are not permitted unless they are being serviced.

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