Brow Lamination Intake Form

Name

First NameMiddle NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Have you ever had your eyebrows laminated, waxed or tinted before?

If so, how was your experience?

I would like to have the service preformed with a sensitivity/patch test prior.

Do you have any allergies or sensitivities? (If so please specify.)

Are you currently pregnant or breastfeeding?

Are you currently taking any medications? (If so please specify)

Please select all that may apply

Are you currently taking/ using any of the following?

If yes, please explain. (If not apply N/A)

Have you bleached or tinted your brows recently?

Have you had your eyebrows microbladed or shaded before, if so when?

I understand that brow lamination is the process of restructuring the brown hairs to keep them in a desired shape, but it is my responsibility to brush my brows daily to maintain the desired look.

I understand that I need to keep my eyebrows free from water, steam, or makeup for 24 hours after the lamination process.

I understand I need to wait 6-8 weeks before getting another brow lamination.

Signature

Although every precaution will be taken to ensure my safety and well being before, during, and after the brow lamination process. I am aware of the possible risks.

I understand that during the treatment, despite all precautionary measures, injury is possible. I will not hold the esthetician (Jordan) or The Lunar Cottage responsible in anyway, for any damages or issues that may arise as a result of having the brow lamination service.

I understand that some irritation, itching, or burning may occur to the skin which comes in contact with lamination agents.

I understand that an allergic reaction is possible.

I understand that it is imperative that I just close all of the information requested on the brow lamination consent form.

I have cited at all conditions and circumstances regarding my health history, medication's being taken, and any past reactions to products or medications.

I agree that if I experience any ill affects with my brows that I will contact the esthetician that perform this service.

Signature

By signing below, I am agreeing to the following:

I have completed this form to the best of my ability and knowledge. I agree to inform the esthetician of any changes in the above information. I agree that I do not have any conditions that would make the requested service unsuitable. I will inform the esthetician of any discomfort I may experience at the time during my service to allow them to comfort and respond accordingly. I agree to waive all liability towards my esthetician (Jordan) and The Lunar Cottage for injury or damages incurred due to any misrepresentation of my health history.

This agreement will remain in effect for this service and future follow ups, conducted by the aesthetician. This form will have to be updated annually to maintain current medical history. I have a read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement into the brow lamination service.

Signature

Today’s date '

Date