Brow Services Consent Form

1

Name

First Name

Last Name

2

Date

3

Phone Number

Please enter a valid phone number.

4

Email

example@example.com

5

Have you used any Alpha Hydroxy Acids (AHA) or glycolic products in the past 48-72 hours?

YESNO

6

Have you used Retin-A, Renova, or Accutane within the past year? If so, when?

7

Are you using any other skin thinning products and/or drugs that thin the blood?

YESNO

8

Do you use tanning beds and/or are exposed to the sun on a regular basis?

YESNO

9

Are you currently taking any medication? If so, please list.

10

Do you have any open skin lesions?

YESNO

11

Do you have any allergies? If so, please list.

12

Please note that waxing/tinting/chemical services can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given an accurate account of the questions and if I have any concerns, I will address these with my Esthetician.

I give permission to my Esthetician to perform the waxing/tinting/chemical procedure we have discussed and will hold her harmless from any liability that may result from this treatment.

I agree to adhere to all safety post care including: no peels, tanning, or wet room services; no swimming/spas/hot tubs for 72 hours after waxing; and all home skin care protocols as recommended by my service provider.

I understand that with any tinting service, it may not last on my skin type or hair for as long as other skin types as all skin types are very different. I understand that any tinting/chemical service can cause a reaction, and that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

13

Are you receiving any kind of tinting during this service?

YESNO

14

If having any tinting services today, would you like a patch test done before service? If yes, please contact me to schedule 48hrs before tinting service. (Recommended for HIGHLY sensitive skin)

YESNO

15

Consent to have your brows photographed and put online for my social media content?

YESNO

16

Signature