Brow Tint and Lamination Consent form

Name

First NameLast Name

D.O.B

Date

Address

Street Address

Street Address Line 2

CityCounty

Post Code

Phone Number

Please enter a valid phone number.

Have you had a patch test?

YesNo

Have you received a brow lamination / lash lift & tint before?

YesNo

Have you ever had a reaction to a brow lamination / lash lift & tint?

YesNo

Do you have very sensitive skin?

YesNo

Have you had microblading or any other semi permanent brow procedure in the last 2 months?

YesNo

Are you on any skin medications (i.e accutane)?

YesNo

Are you currently taking any skin routine such as applying AHA, BHA, Retinol (ex. anti-aging skin prosecutors)?

YesNo

Are you pregnant?

YesNo

Do you have a wound or scar tissue or pimple in the area to be treated?

YesNo

Disclaimer

I hereby declare and acknowledge that:

I am at least 18 years of age and not under the influence of alcohol or drugs, or anything that might impair my ability to execute this waiver. I also understand that this is a binding agreement. I understand that this Agreement is binding and that I must read and fully understand all information above.

I have read and fully understand the brow lamination, lash lift and tint client and consent form in its entirety and have answered everything to the best of my ability. I have not misrepresented myself, nor have I withheld any medical information, surgical state, or condition.

I understsnd that the results may vary due to hair type and strength. I understand my aftercare is important and my responsibility to follow in order to get the best results and longevity from the treatment.

If I feel any discomfort during the treatment I will let my therapist know immediately.

I confirm and agree that I wish to engage the services of Nude Aesthetics and Beauty to perform the brow lamination/ lash lift and tint procedure on myself.

PUBLICITY MATERIALS I authorise the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I hold the practitioner harmless for any liability resulting from this production. I waive my rights to any royalties, fees and to inspect the finished production as well as advertising materials in conjunction with these photographs.

I certify that I have read the above consent and I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.

Signature

Brow Lamination/ Lash Lift & Tint Consent Form