Eyelash Extension

Eyebrow Lamination & Tint

Client Consent Form
Appointment Date

MonthDayYear
Date of appointment
Hour MinutesAM/PM Option
Client Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Apt. Unit

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Emergency Contact Information

First NameLast Name
Emergency Contact Number
Format: (000) 000-0000.
Have you had eyebrow lamination and/or tint performed before ?
If yes, when? And what service ?
*If you have inflammation, swelling, cuts or abraisons, in the treatment area, the procedure cannot be done.*
Are you pregnant or breastfeeding ?
PLEASE CHECK ANY OF THE FOLLOWING THAT MAY APPLY TO YOU:
RELATING TO THE SKIN
Other Medical Information
If none, please submit N/A
By checking the following boxes, confirm that you willingly consent to the following terms and conditions:
*I understand that a patch test does not guarantee that an allergic reaction will occur*
*I have completed this form to the best of my ability and acknowledge and agree to inform the technician on any changes in the above information. I have been informed and understand the contraditions to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsutable.*
Client Signature
Date

MonthDayYear
Date
Should be Empty:

Eyebrow Lamination & Tint