PERMANENT MAKEUP CONSENT

BROWSBYANGI

Brow Lamination + Tint
Patient Data
Patient Name

First NameLast Name
Gender
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact Person

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
HISTORY/CONSENT
* I understand the Risks / Complications / Side effects / Consequences associated with having an eyebrow lamination. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blurriness could occur.

* Aftercare instructions: Avoiding getting the brow area wet for 24 hours, avoiding contact with direct sunlight, sunbeds, saunas, steam rooms, and swimming pools for the next 48 hours, and avoiding excessive rubbing or touching of the treated area for 24 hours.
Please answer the questions below?
Are you under the age of 18? yes or no
Signature of the Patient
Date

MonthDayYear
Date
Please let us know if you would you like to receive a copy of this statement and consent.
Should be Empty:

BROWSBYANGI