General Services Registration Form

Medical History that could indicate allergies to Brow Lamination, Brow Tint, Brow Henna, Waxing or Lash Lift:
I understand and agree
Did you book a patch test prior to coming in for your appointment?
Is this your first time getting this service done?
Do you have sensitive skin/eyes?
Are you prone to or have you had a wax burn in the past?
Are you currently on acne medication (Accutane, Tactupump, Sandoz, Tretinoin)?
Did you use exfoliants such as alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), or retinols in the last 48 hours?
Are you allergic to p-phenylenediamene (PPD)?
This is an ingredient found in dyes such as Tint and Henna.
Are you pregnant or breastfeeding?
Have you recently (less than 6 weeks ago) done microblading or powder ombré?
Have you had any issues/reactions when getting this service done from a different technician?
Do you have Alopecia?
Have you recently got a chemical peel, microneedling or facial that includes exfoliation?

Hygiene and Safety
All tools are disinfected using PREempt CS 20 chemical disinfectant. Surface areas are cleaned and disinfected using Cavi Wipes.

Customer Details: