NkdSkn Esthetics Brow Lamination/ Brow Tint/ Lash Lift/ Tint Consent Form

Name

First NameLast Name

Date of Birth

Date

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Appointment Date

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about us?

If referred, by who?

Are you taking any medications that make you photosensitive?

List medications/supplements you are currently taking.

Are you currently using Retinal, Retin-A, Tretinoin, Accutane, or exfoliating medications?

Have you used Accutane within the last 6 months?

Do you have sensitive skin or allergies to cosmetics, dyes, or adhesives?

Do you currently have eczema, psoriasis, dermatitis, or rosacea in the brow area?

Have you had a Chemical Peel, Laser Treatment, Microdermabrasion in the last 2 weeks?

Do you have cuts, irritation, sunburn, or open skin near the brows?

Have you had a reaction to brow tint, lamination, or waxing before?

Type a question

Any known allergies?

Do you currently have or have had any of the following medical conditions that could compromise your skin and/or services being offered

Have you ever received any botox or fillers? if so, where and when?

Have you ever experiencesd claustrophobia?

Have you received any of these facial hair removal services in the last 7 days?

Have you had a Brow Lamination or Lash Lift done before? IF SO, WHEN?

Are you pregnant or breast-feeding?

YOU MAY EXPERIENCE SKIN SENSITIVITY/ THINNING WHICH CAN RESULT IN SKIN LIFTING FROM THE FOLLOWING PRODUCTS:

SUN BURNED, SKIN RETINAL, CERTAIN MEDICAL CONDITIONS, PREGNANCY, ANTIBIOTICS, MENSTRATION, OR OTHER MEDICATIONS NOT LISTED.

I acknowledge that my skin might experience temporary irritation, tightness, redness or slight swelling which usually dissipates within 72 hours depending on skin sensitivity.

I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.

I acknowledge that this treatment is strictly elective cosmetic procedure and no medical claims have been expressed or implied.

I UNDERSTAND THAT IF I BEGIN USE, OR ARE CURRENTLY USING ANY OF THE PRODUCTS LISTED IN THE ABOVE WARNING AND DONT NOT INFORM THE ESTETICIAN PROIR TO CURRENT OR FUTURE TREATMENTS, I ACCEPT FULL RESPONSIBILITY FOR ANY ADVERSE REACTIONS

I acknowledge that I should avoid the use of Retin-A type products, aggressive exfoliation, waxing, and products containing acids that are not part of the recommended take-home regimen for 1-2 weeks following treatment.

I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments

I release NkdSkn Esthetics of any liability associated with any injuries and /or current and future conditions resulting from the skincare procedures or products.

The esthetician performing the service will not be held liable for any damages caused to me, my eyebrows,or lashes by any reason, including allergic reaction to previous procedures such as previous henna/tint. on the brow hair or lashes, skin sensitivity, and failure to follow aftercare instructions.

I Understand that a Brow Lamination is a process of reconstructing the brow hairs to keep them in a desired shape, but it is my own responsibility to brush them daily to achieve the desired look.

I Understand that the brows after Brow Lamination or lashes after a Lash Lift must stay dry for 24-48 hours.

Signature

NkdSkn Esthetics Brow Lamination/Brow Tint/Lash Lift/Lash Tint Consent Form

Medical & Brow History

Female Clients

PLEASE READ THE FOLLOWING WARNINGS

Consent & Signature

NkdSkn Esthetics Brow Lamination/Brow Tint/Lash Lift/Lash Tint Consent Form

Medical & Brow History

Female Clients

*PLEASE READ THE FOLLOWING WARNINGS*

Consent & Signature

PLEASE READ THE FOLLOWING WARNINGS