Brow Lamination Consent Form

IN ORDER TO PERFORM THE BROW LAMINATION PROCEDURE SAFELY, IT IS REQUIRED THAT YOU PLEASE ANSWER THE FOLLOWING HEALTH QUESTIONS TRUTHFULLY.

ALL INFORMATION DISCLOSED IN THIS FORM WILL BE KEPT CONFIDENTIAL AND WILL ONLY BE USED FOR PURPOSES OF DETERMINING WHETHER YOU ARE AN IDEAL CANDIDATE FOR THIS PROCEDURE.

DO YOU HAVE PROBLEMS WITH HEALING OF WOUNDS?       Yes   No

ARE YOU TAKING MEDICATION FOR BLOOD THINNING?   Yes   No

HAVE YOU TINED YOUR EYEBROWS IN THE LAST 6 MONTHS USING HENNA OR TINT/DYE?         Yes   No

HAVE YOU EVER BEEN ALLERGIC TO OR HAVE HAD AN ALLERGIC REACTION TO PERM SOLUTION?    YES   No

HAVE YOU EVER BEEN ALLERGIC TO OR HAVE HAD AN ALLERGIC REACTION TO HAIR DYE?   Yes   No

HAVE YOU APPLIED RETIN-A OR AHA (ALPHA-HYDROXY ACIDS)     Yes   No

Do you have any allergies? Please list

Do you have any skin conditions? Please list

Any other concerns your artist should know?

Type a question

I understand that brow lamination has some inherent risk of irritation to the area around the eyebrows, including the eye itself, and could result in stinging or burning, blurry vision and potentially blindness, should the products enter into the eyeI understand that during this service, despite all precautionary measures, injury is possible. I release this artist and/or business performing the service from any damages caused to me or my eyebrows, including but not limited to allergic reaction, reaction to previous procedures on the brow hair, and/or skin sensitivity. If these issues persist, I am to consult a medical professional at my own expenseI have read and understand the aftercare instructions that I am to follow after the procedure, and understand that adverse reactions may occur if I fail to follow the Brow Lamination Aftercare Instructions.I understand that over the course of several weeks, the laminated shape of my brows will gradually wear off. Future lamination services will be required to keep the shape of the brows, and I understand that I will need to wait 6-8 weeks between each service.I understand that everyone's hair and skin type is unique, and results cannot be guaranteedI certify that all of the responses that I have given on this form are medically true and accurate.I have read and accepted the risks as presented in this consent form and verbally by my artist. I have been given the opportunity to ask my artist any questions as it relates to this service. As a result, I have sufficient information to give this informed consent.I consent to having my before and after photos taken for advertising purposes. I understand that these photos may be posted to social media sites for marketing purposes.

By signing this form, I am acknowledging and understand the terms of this service as well the information listed above and given by the service provider. This agreement will remain in effect for the duration of the service, and any
proceeding brow lamination services in the future conducted with this artist. I consent to this brow lamination service and certify the accuracy of responses I have provided above.

I have read, understand, and agree to all of sammy beauty’s policies. I understand that my card will be held on file and will not be charged without notice. I understand I will be subject to paying fees: 30% for any late reschedules, 50% for not showing up at my appointment without any notice, for the service(s) booked.

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