Waxing Consent & Appointment Form

Brow Wax Lamination & Tint Consent Form
Client*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Have you ever had your eyebrows laminated?*

YesNo
Have you ever had a reaction to hair perming products?*

YesNo
If yes, please explain. blanks
By checking the following boxes, confirm that you willingly consent to the following terms and conditions:*

I give permission to my therapist to perform the wax, lamination and tint procedure we have discussed and will hold her harmless from any liability that may result from this treatment.I understand that despite all precautionary measures, an allergic reaction may occur.I understand skin irritation may occur, which includes redness, peeling, swelling, bumps and itching.If I have any concerns, I will address these with my technician.I have read and understand the post-treatment home care instructions and understand how important it is to follow all instructions given to me for post-treatment care.
This procedure is NOT recommended if you have the following. Please check any and all that apply to you:

Psoriasis/ severe exzemaRecent eye surgeryAlopeciaRecent Microblading (must be healed over 8 weeks)SunburnSuper sensitive skinTaken any blood thinnersPink eyeScar tissue in the areaPregnant/ breastfeedingRecent use of Retinol, Retin-A, Accutane, AHA, BHA, etc.
Post Treatment Instructions

Do not apply Retin-A, AHA or exfoliate around the brow are for three days before or after treatment. No self tanning products should be used on the face for 48 hours after treatment. Redness and mild swelling is normal after your treatment. Avoid putting water on your brows for the first 48 hours. Gently brush your brows every day. Do not trim brows. No makeup on the area for 48 hours after treatment.
I verify that the information I have provided on this form is truthful and accurate. I have read, understand, and checked all the terms and conditions. I release the Gabyylashedxo, and all of the parties related to Gabyylashedxo from any and all of the claims and demands including damages, diseases, and or injuries.
Date*

MonthDayYear
Date
Client Signature*
Should be Empty:

Brow Wax Lamination & Tint Consent Form