Your Information

1
Client Name* This field is required.
First Name
Last Name
2
Birth Date* This field is required.
Month
Day
Year
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Address* This field is required.
Street Address
City
State / Province
Postal / Zip Code
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Montserrat
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Nagorno-Karabakh
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New Caledonia
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Nigeria
Niue
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Paraguay
Peru
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Poland
Portugal
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Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
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Saint Lucia
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Other
Country
6
How did you hear about us?
Social Media
Referral
Flyer
Other
7
Emergency Contact Name* This field is required.
First & Last Name
Phone Number
8
Please check any of the following that apply* This field is required.
Allergies
Hormone Imbalance
Hypopigmentation
HIV/AIDS
Hyperpigmentation
Acne
Brown Spots
Pregnant/ Breast Feeding
Other
9
If you checked yes to any of these please provide further information.
10
COVID 19* This field is required.In the last 14 days have you or has anyone you live with experienced any of the following symptoms:
Had a fever (greater than 100.4°F / 38°C)
Had a Cough
Shortness of breath or having trouble breathing
Have tested positive for COVID-19
Have been in contact with someone who has tested positive for Coronavirus, has COVID-19 or is being evaluated for Coronavirus
Traveled abroad
11
If you have marked any of the above questions or you are unsure, you must cancel your appointment immediately & seek medical advice. You will not be charged a cancellation fee & we will reschedule your appointment for a later date once the period of self isolation is over, as per government guidelines.
12
Is there any other condition or significant information we need to know that may affect you during or after the procedure?
13
Signature* This field is required.By signing below I voluntarily seek the service provided by Studio Finesse. If I have any concerns, I will address these with my technician. I give permission to my technician to perform eyelash lifting, brow lamination and waxing procedures we have discussed and will hold her and her staff harmless from any liability that may result from this treatment including contracting COVID-19. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand the procedure and accept the risks. I do not hold the technician, responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed.
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