Eyebrow Lamination Waiver

Brow Lamination + Shaping Waiver
Thank you for booking your eyebrow service with me, Ashlee Tomlin!

Please fill out this waiver form prior to your appointment to ensure all information is current. This will allow time to review your answers and reach out if there are any contraindications that could affect your service.

Please Note: Brow Lamination is a process of reconstructing the brow hairs to keep them in a desired shape. Brow Lamination lasts approximately 6-8 weeks; however this will differ person to person based on factors like skin type, hair growth rate, etc.

All information that is shared in the Brow Lamination + Shaping Waiver will remain confidential to protect your privacy and comfort.
Thanks again, see you soon!
Name*

First NameLast Name
Referred by:*
Phone Number*
Please enter a valid phone number incase your service provider need to reach you.Format: (000) 000-0000.
18-2526-3536-4546-5656-6666+
Walk-inInstagramGoogleYelpA friend or family memberFarmer's MarketBB Meme WebsiteOther
I AgreeI Disagree
WAXING PRECAUTIONS: PLEASE READ
- If you currently have: a sunburn, irritated skin, or an open wound- please reschedule.
- If you are currently pregnant, please note the skin will be more sensitive and irritation can occur. Tweezing is recommended.
  Important Note: Women may experience extra sensitivity to waxing a week prior to their menstrual cycles.
- It is recommended you wait 7 days if you have recently had: a facial, used OTC facial scrubs or chemical exfoliants or retinol– please inform your service provider. Tweezing may be recommended.
- If you have had a Light, Medium, or Deep Chemical Peel recently- please wait 2-4 weeks depending on the depth before receiving a waxing or tweezing service. Let your service provider know of any recent treatments. You may need to obtain your physician’s permission/ sign off before getting waxed.
- If you have received any recent Cosmetic or Reconstructive Surgery and/or Laser Skin Treatment within the last year. Clients will need to obtain and bring a physician’s consent letter before waxing.
- If you have a history of Cold Sores/ Fever Blisters, it is recommended to take antiviral medication for 7 days before your appointment. Consult your Doctor.
  Let your service provider know if you have a history of Cold Sores/ Fever Blisters. Waxing and Tweezing can trigger a flare up.
- If you are Diabetic, please note waxing can cause irritations and poor wound healing. Consult your Doctor before getting waxed. Tweezing may be recommended.
- If you are currently using any prescription Acne medications, it is not recommended to receive a waxing service due to high skin sensitivity. Clients should be off any prescription Acne medication for a minimum of 3 months prior to receiving a waxing service. This also includes steroids and prednisone. Clients should be off Accutane for at least 12 months.
- If you are currently using Hydroquinone. If your prescription is finished, please wait 10-14 days before getting waxed.
- If you take: Blood-Thinning Medications, Antihistamines, Cortisone, Thyroid Medication, or Blood Pressure Medications it is not recommended to receive a waxing service due to high skin sensitivity.
- If you are taking birth control, HRT, or antibiotics please note your skin may be more sensitive to waxing. Tweezing is recommended.
- If you take Medications for an Autoimmune Disease i.e. Lupus,
  Waxing and tweezing can trigger a flare up and it is not recommended.
BROW LAMINATION + SHAPING PRECAUTIONS: PLEASE READ

Brow Laminations + Shapings are NOT recommended if you are or have:
- A Sunburn
- Pink Eye
- Scar Tissue in the Treatment Area
- Pregnant/ Breast Feeding
- Currently Using Prescription Skincare i.e. Accutane, Tretinoin, Hydroquinone
- Recently Used: Retinol, AHA, BHA, Other Exfoliating Products.
  (Side Note: Please stop using ALL exfoliating products 1 week prior to your brow lamination service.)
- Skin Conditions such as: Psoraisis, Eczema, Rosacea
- Any Recent Chemical Peels. Please wait 4-6 weeks post peel to get a Brow Lamination.
- Diabetes
- Current or Recent Chemotherapy Treatments (You will need Doctor's approval note/ signature).
- Prescription Medications that Thin the Skin (topical or ingested)
- Irritation or Allergy to Perm Solution
- Recent Microblading/ Other Permanent Brow Makeup
  (You must be healed for 8 weeks before getting a Brow Lamination.)
Brow Lamination is a process of reconstructing the brow hairs to keep them in a desired shape. To maintain the shape post service, it will be the Client's responsibility to brush them daily to achieve the desired look day to day.

Do NOT get any water on your freshly laminated brows for a minimum of 24 hours. If you do, this will affect your results.

Do NOT get any makeup near the treated area for 24-48 hours.
This includes: brow gel, concealer, foundation, eyeshadow and so on.

While safe, it is important to note that this service does have some inherent risk of irritation to the area around the eyebrows- including the eye itself. This could result in stinging, burning, blurry vision, and potential blindness if the product solution enters the eyes.

Please understand that even with all precautionary measures taken before and during the service, there is still a risk of injury.
Redness and mild sensitivty is normal. If discomfort continues after your service, please contact your medical provider at your own expense.

To minimize any issues, it is important to follow ALL aftercare instructions provided by your practioner. Failure to follow through on aftercare may results in issues such as: irritation, ingrown hairs, bacterial infection, rashes, redness, and/or scarring.
I understand that the Brow Lamination + Shaping service has inherit risks associated with it and have been made aware of them.I am aware and understand that discomfort may occur despite all precautions taken to ensure a safe service. If discomfort persists, I will contact my Esthetician and a Medical Provider at my own expense. Ashlee Tomlin, Koji Kuninaga, and BB Meme Salon Hillcrest will NOT be held liable for any damages caused to me or my eyebrows by any reason such as: allergic reaction, previous procedures done by another service provider, skin sensitivity, and failure to follow the Brow Lamination After Care instructions.I agree to follow all After Care instructions to ensure the best possible outcome and results for my Brow Lamination + Shaping service.I agree to follow all After Care instructions to ensure and understand that failure to follow the instructions can and may result in: bacterial infection, irritation, rashes, ingrown hairs, redness, and/or scarring.I affirm that I have read and understood all the precautions written above.
Colophony (Pine Rose)LatexBeeswaxLanolinFragrance/Essential OilsDyesNo Allergies
YesNo
Never BeenLast WeekLast Month2-3 Months AgoAt Least 6 Months Ago
Dry: Less Oil, Flaky, Rough Patches, Visible Lines, Less Elasticity.Normal: Balanced Skin, Even Tone + Texture, Good Elasticity, Minimal Breakouts.Combination: Mix of Dry and Oily, Prone to Acne, Tend to have Thicker Skin.Oily: Produces Extra Oil, Visible Pores, Prone to Acne.I'm not sure what my skin type is.
What are your current TOP 3 skin concerns and what improvements would you like to see? *
I'm on a regimen you recommended and I'm enjoying it.I have a regimen that works for me.I have a regimen but have yet to notice any significant improvements yet.I don't think my current regimen works for me and am open to hearing suggestions.I would like help building a complete regimen.
YesNo
I agree.I disagree, my treatment may need to be adjusted or rescheduled.
YesNo
YesNo, I've been off my acne medication for at least 6+ months.I don't take acne medication.
Can you please list ALL the products you use in your skincare regimen? Example: Cleanser(s), Toner(s), Serum(s), Face Mask(s), Moisturizer(s), and SPF. Please also include the product(s) that contain any active or exfoliating ingredients. *
Heart ConditionEpilepsyDiabetesFrequent or Severe HeadachesMetal Implants / PacemakersLow or High Blood PressureTaking Birth Control / Depo ShotHRT (Hormone Treatment)Eczema / PsoriasisCold SoresFacial SurgeryLasersBotox / FillersFacial Waxing / ElectrolysisRecent Facial PiercingsTanning / Tanning BedsNo Medical or Cosmetic Procedures
YesNo
If Yes, please explain:
Do have any allergies? Products used in the treatment room are botanically derived such as papaya, lavender, and so on. Please list any irritants and/or allergies below:*
PregnancyEpilepsy / Seizure DisordersYou're under the age of 12.You have had a recent Skin Cancer lesionCurrently taking photo-sensitive medications like lithium, melatonin, phenothiazine, antipsychotics, amiodarone, digoxin, or you're on antibiotics.Steroidal Medications / This treatment should not be performed on those who have had steroid injections within the last 72 hours.I am not experiencing any of the listed contraindications.
Without names, are you taking any medications where you noticed it has affected your skin? Example: redness, rash, hives, blisters, skin thinning, pain, bruising, and so on. If you are not taking any medications, please put "No Medications."*
Do you take any vitamins? For example: Multi-Vitamin, Spirulina, Chlorella, B12, Biotin, Magnesium, Vitamin D, Protein Powder, and Other? If you are not taking any vitamins, please put "No Vitamins."*
Yes, at the gym.Yes, at home.Yes, outdoors.No
I would appreciate a quiet atmosphere.I would like a quiet atmosphere with brief explanations of facial steps.I would like to chit chat.No preference.
Yes. Full face.Yes. Only Brows, No face.
Consent and Release:

The Brow Lamination + Shaping Waiver form has been completed truthfully and to the best of the Client’s knowledge. By reading through and completing this form, the Client declares the answers given are to the best of their knowledge and they understand the precautions mentioned.
The Client agrees that they have no medical or cosmetic condition(s) that may affect the brow service. The Client understands the procedure and accepts the risks. False or misleading answers can lead to complications and/or undesirable results.

The brow services received at BB Meme Salon Hillcrest are voluntary. The Client understands the risks and consents to Ashlee Tomlin providing the service.
This agreement releases Ashlee Tomlin, Koji Kuninaga, and BB Meme Salon Hillcrest from any potential conditions that may arise after treatments that were not previously disclosed at the time and day of service. This agreement will remain in effect for the duration of the service and any proceding brow laminating services in the future with Ashlee Tomlin (Licensed Esthetician).

By Signing below, the Client gives their full consent and understanding to the service along with its precautions and does NOT hold Ashlee Tomlin, Koji Kuninaga, and BB Meme Salon Hillcrest responsible for any conditions that were present or may arise post service.
Signature*
Date*

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Date
Thank you so much for taking the time to fill out the form.
Looking forward to seeing you!
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