Brow Lamination, Wax, and Tint Consent Form

Brow Lamination, Wax, and Tint Consent Form
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
BROW HISTORY: Have you ever had your brows laminated?*

YesNo
If yes, have you ever had an adverse reaction? Please explain.
Have you ever had an allergic reaction to hair perming products?*

YesNo
If yes, please explain:
Are your eyebrows tattooed?*

YesNo
If yes, when did you get them done:
Permanent makeup brows should be fully healed (6-8 weeks) before a brow lami appointment.
Are you currently using any skin care or exfoliating products around the eyebrows with the following ingredients: Retin-A, Glycolic Acid, Salicylic Acid, Alpha Hydroxy Acid (AHA) or BHA products, Cortisone or Acne products? (Must stop using these products for a minimum of 4 weeks before appointment)*

YesNo
MEDICAL HISTORY: Are you currently pregnant or breastfeeding?*

YesNo
For clients who are pregnant or breastfeeding, it is essential to consult with a doctor and obtain their consent before proceeding with the treatment. Pregnancy and breastfeeding can increase hormone levels, leading to elevated sensitivity. Therefore may result in adverse reactions and inconsistent results.
Are you currently taking any medications? If yes, please list:
Are you currently using Retinol around the eyebrows or taking Accutane/ similar medications?*

YesNo
Do you have any of the following conditions? (Please check all that apply)*

EczemaAlopecia in the brow areaDermatitis / Psoriasis around the eyesRecent eye surgeryRecent eye infectionHypersensitive skin or eyesSunburned skinOther
Please list any illness or condition you are currently being treated by a physician for:
Although every precaution will be taken to ensure my safety and wellbeing before, during and after the brow lamination process. I am aware of the following information and possible risks. Please check each one after reading and agreeing:*

I understand that during the treatment, despite all precautionary measures, injury is possible. I will not hold my brow artist, Samantha Thang at Lash Maven Co, responsible in any way for any damages or issues that may arise.I understand that some irritation, itching, or burning may occur to the skin which comes in contact with the lamination products.I understand that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc.I understand that an allergic reaction is possible.I understand that it is imperative that I disclose all of the information requested on the client consent form.I have cited all conditions and circumstances regarding my health history, medications, and any past reactions to products.I consent to "before and after" photographs of the purpose of documentation, potential advertisement and promotional purposes.I agree that if I experience any ill effects with my brows that I will contact my artist.I understand that brow lamination is the process of reconstructing the brows 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 wait a minimum of 6-8 weeks to get my brows re-laminated.I understand that I should consult with a physician if pregnant or breastfeeding before getting a brow lamination.I give permission to, Samantha Thang at Lash Maven Co, to perform the brow lamination, waxing, and tinting procedure.
By signing below, I agree to the following:

I have completed this form to the best of my ability and knowledge. I agree to inform my artist of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my artist of any discomfort I experience during my treatment to allow them to adjust accordingly. I agree to waive all liability towards my artist and the business that may result in this treatment.

This agreement will remain in effect for this procedure and all future follow-up appointments. I understand that this consent agreement is legal and binding. I have read and fully understand all the information in this agreement. I am over 18 years of age and consent to this agreement and procedure.
Date*

MonthDayYear
Date
Signature*

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