Although every precaution will be made to ensure your saftey and well-being before, during and after your tint/henna application, please be aware of possible risks below.

I understand that tinting/henna brows has some inherent risk of irritation to the obitial eye area, including the eye itself, and could result in stinging or burning, blurring vision and potential blindness should the tint enter the eye

I understand that if the tinting/henna agent, developer or mixture of both accidently meets my eye, my eye will be flushed with water and medical attention may be required.

I understand that some irrritaion, itching, or burning may accur to the skin which encounters the tinting/henna agent

I undersand the henna tint used will contain a small amount of paraphenylenediamine which can cause allergic reactions

I understand that, while every attempted will be made to provide me with my chosen color, everyones hair absorbs color differently and my results may not be the color i intitally wanted.

I understand that over the course of several weeks, the tint will gradually light and fade, Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4 weeks.

I have read the information above. If i have concerns, I will address these with my esthetician. I give premission my esthetician to preform the tint/henna 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, presciption 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. In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetican immediately. I agree that this consititutes full disclosure, and it supersedes any previous verbal and written disclosure. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for disscussion to have any questions answered. I underand the procedure and accept the risks. I do not hold the esthetician, whos signnature 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 preformed.