DermaLux Brow or Lash Lamination & Tint Information and Waiver Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Service

Brow LaminationBrow TintLash liftLash tint

Have you had reaction to previous brow lamination or lash lift?

YesNo

Do you have a very sensitive skin?

YesNo

DId you have microblading or any semi-permanent brow procedure in the last 2 months?

YesNo

Are you taking any skin medication (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 or currently breastfeeding?

YesNo

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

YesNo

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 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 confirm and agree that I wish to engage the services of DrrmaLux to perform the brow or lash tint or lamination procedure on myself. Also i am aware that color or shape results are not guaranteed.

I acknowledge all sales are final and no refunds. 24hour cancelation policies will be applied of 49.00 or redemption of purchased voucher.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.