HENNA BROW CONSENT FORM

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Email*

example@example.com

How did you hear about us?*

Emergency Contact*

Full Name Cell Number

24- hour notice is required for any canceled or rescheduled appointment or up to 100% of service price will be charged. Failure to show without notice will require in full payment of service booked. We do not offer monetary refunds on services rendered. We do have a 7-day policy in place on services in which a client can come back and have corrections made provided we are notified of any issues within 24-48 hours of initial service. Client must contact provider within 24-48hours after service rendered of any issues. Fees may apply. By choosing yes, I’m acknowledging I have read, understand, and agree with the terms of these policies.*

Yes

List any known allergies:*

N/A if none

Is this your first brow henna?*

YesNoI’ve had a brow tint, but not henna

If you've had henna or brow tint before, did you experience any adverse reaction to either service?*

yesno

If yes, please describe the reaction.*

N/A if none

Did you seek medical advise from a doctor or specialist as a result of this reaction?*

YesNo

If yes, what was the advice of your doctor/treatment given?*

N/A if none

CURRENT CONDITIONS, PREVIOUS DISCOMFORT, STINGING OR ADVERSE REACTIONS: Please pick any that apply:*

List any medications you're on*

N/A if none

After Care

Avoid exccess hot water and steam on the brows for the first 24 hours.

Avoid shampoos & conditioners, makeup & makeup removers, creams, and serums on the brow area for the first 24 hours.

When cleansing the face and brow area after the first 24 hours, cool water will help the henna to last longer than using warm/hot water.

Avoid exfoliating and rubbing on the brow area for the next few weeks to help the Henna adhere to the skin longer.

Agreement

I understand that there are risks associated with the Henna Brows procedure, as with any beauty treatment.

I understand that the brows and skin will be stained with henna.

I also understand that I will need to be lying in a reclined position for 45-60 minutes.

This agreement will remain in effect for this brow henna procedure and future brow henna procedures conducted by my technician.

I understand that this agreement is binding and that I have read and fully understand all information above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

I release my technician and salon from all liability associated with this procedure.

I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.

RESULTS MAY VARY. Our eyebrows are each unique and require slightly different processing times based on our skin's oiliness or dryness. If desired results are not achieved, processing times will be adjusted for future henna applications. There are no guarantees for how long the brow henna will last, on average it lasts on the skin between 7-14 days and on the hair 6-8 weeks. Our company or salon is not responsible for any technician errors.

I request and consent to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted, may indicate my sensitivity / allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services(s).

May we use your photos/videos per the above paragraph?*

YesNo

Signature*

HENNA BROW CONSENT FORM

Our Policies