Lash Lift / Brow Lamination

Name

Are you 18 or older? Parent / guardian's consent needed if under 18.

YesNo

Date of Birth

Date

Phone Number

Email address

example@example.com

How did you hear about Wax and Beauty?

Do you have any of the following conditions (check all that apply):

Are being treated for an eye illness, eye injury or skin conditions? If yes, please describe.

YesNo

If yes, please describe

Do you currently have irritated, itchy or watery eyes?

YesNo

Are you allergic to perms, hair color or tape?

YesNo

List all other allergies

List medications and supplements including eye drops you take regularly

Are you currently pregnant?

YesNo

Have you ever had a lash lift or brow lamination, if yes, which one?

Lash LiftBrow LaminationNO

If yes, when was your last procedure

Have you ever had an adverse reaction to an eyelash tint, lift or brow lamination?

YesNo

If yes please describe

Have you had permanent eye or brow makeup done within the last 2 weeks?

YesNo

If yes please describe

Additional concerns / comments you want me to know

THE EYELASH LIFT AND TINT, AND THE BROW LAMINATION PROCEDURES ARE PERFORMED WITH THE PROPER TECHNIQUE, PRODUCTS, AND INSTRUMENTS, AND WITH YOUR SAFETY IN MIND. HOWEVER, THERE STILL ARE SOME RISKS ASSOCIATED WITH THE PROCEDURE(S THIS CONSENT FORM IS INTENDED TO INFORM YOU OF

I understand that as part of the procedure(s), eye/skin irritation, redness, swelling, pain and discomfort can occur. And although rare, eye infection or allergic reaction can occur. I agree to seek medical attention at my own expense if I experience any of these conditions.

I agree that if the tint or perming agents comes into contact with my eye, my eye will be flushed with water and I will seek medical attention at my own expense immediately.

I understand that the procedure(s) can take up to 90 minutes. I agree to lie down with my eyes closed for the duration of the procedures

I agree to the aftercare procedures recommended by the technician. I understand not adhering to the aftercare procedures can impact the results of the lash lift/tint or brow lamination.

I understand that results of the procedure may vary based on my natural lashes and brows and my final result may not be what I initially envisioned.

I give the technician permission to photograph my lashes and/or brows for their own marketing and promotional purposes. I understand that the lash lift/tint procedure and brow lamination is semi-permanent, and will require a retouch and upkeep.

I completed the above form to the best of my knowledge and consent to the lash lift, brow lamination, and/or tint procedure. I have had the opportunity to ask any questions and have received satisfactory answers. I understand the risks and potential side effects associated with the procedure(s.

I understand that the results of the procedures are not guaranteed and may vary from person to person.

I am over the age of 18 and consent to the procedure(s / will not hold the technician, salon, or employees liable for any issues not disclosed at the time of my service or any adverse effects from the procedure(s This agreement remains in effect for this procedure and any follow-up appointments.

Client Signature

Date

Lash Lift / Tint + Brow Lamination

Lash Lift/Tint + Brow Lamination Consent Form

THE RISKS OF THE PROCEDURES AND TO OBTAIN YOUR INFORMED CONSENT FOR THE PROCEDURES