Lash and Brow Tinting Consent Form

Date

Date of Birth

Date

Name

First NameLast Name

Phone Number

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

Email

example@example.com

How did you hear about us?

If referred, by who?

Have you ever used hair color before?

Have you ever had an allergic reaction to hair color?

Do you wear contacts ?

Do you have any medical conditions such as diabetes, lupus, or auto-immune diseases? If yes, please describe

Please list any current medications you are taking, including over-the-counter herbs, vitamins, and supplements:

List any allergies you have:

Have you ever had your brows or lashes tinted?

If you had an adverse reaction to previous tinting, please explain:

I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.

I acknowledge that I must adhere to the policies. I understand all services require a non-refundable deposit of $20. The deposit will be credited towards my appointment. I agree to arrive 10 minutes prior to my appointment.

I understand that cancellations or rescheduling an appointment must be done with at least 24 hours notice. Failure to attend without prior notice will require a deposit fee to secure my next appointment. I understand that after 15 minutes of tardiness, my appointment may be subject to cancellation, and I will be responsible in accordance with the “No-show” policy. Tardiness may also result in shortened service time and full service charge.

I understand the potential risks associated with lash and brow tinting, including irritation to the eye area and skin, and the possibility of residual staining.

I agree that if I experience any of these conditions with my eyelashes, brows, or eyes, I will contact my technician. If I choose to consult a physician, it will be at my own expense.

I acknowledge that my chosen color may vary based on individual hair absorption, and that re-tinting may be necessary every 3-4 weeks.

I release Em Beauty & Skin and service providers from all liability resulting from the tinting procedure.

I certify that I have accurately answered all questions and have read and understood the above information.

I provide consent for the tinting procedure as discussed.

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service.

This agreement will remain in effect for this procedure and all future procedures conducted by my technician.

Signature

Lash and Brow Tinting Consent Form

Health History:

Consent: