• Brow Service Consultation Form

    Please fill out this form directly after booking your appointment.

  • All fields marked with a * are required and must be filled.

  • Format: (000) 000-0000.
  • Have you ever had a brow lamination, tint, or wax?*
  • Have you ever had an adverse reaction to hair dye or hair perming products?*
  • Do you have very sensitive skin?*
  • Are you taking any skin medication (i.e. Accutane)? Please note that if you are currently taking or have taken accutane within the past year, you CANNOT receive a brow service.*
  • Are you currently using any products containing AHA or BHA, retinol, or any acne topical such as tretinoin? If yes, please note you must discontinue use of of these products at least 1 week BEFORE your appointment*
  • Have you had previous micro blading or any semi-permanent brow procedure within the last 2 months?*
  • Have you gotten Botox or any other facial fillers within the last 2 weeks?*
  • Have you received an advanced facial treatment such as a chemical peel or microdermabrasion within the past 2 weeks?*
  • Are you currently pregnant or breastfeeding?*
  • Are you currently sunburnt?*

  • Read the following before signing.

    By signing this agreement, I consent to the procedure of a brow service by my Esthetician. Please note that waxing may cause certain reactions such as skin lifting, redness, swelling, tenderness, etc. I understand that certain medications are contraindications for brow services and have accurately responded to the questions asked above, including all known allergies or prescription drugs/products that I am currently ingesting or using topically. I understand that if I am currently taking Accutane or have taken Accutane in the last six months, I cannot receive a brow service. Other common skin medications/products that are contraindications for brow services include, but are not limited to, Adapalene, Renova, Tretinoin, Retional/Retin A, AHA, BHA, Glycolic acid. I understand that, as directed by my Esthetician, I may need to discontinue use of certain skin medication/products before I am able to receive a brow service. I am willing to follow recommendations made by my Esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home products/post treatment care, I will consult the Esthetician immediately. I understand that my Esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I give permission to my service provider to perform the brow procedure we have discussed and will hold all staff harmless from any liability that may result from this treatment. I do not hold the service provider responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today. I understand that there are many factors that may affect the longevity of the brow lamination or tint, such as premature water/moisture contact, weather conditions, and activities involving exposure to high temperatures. Acknowledgment and waiver: I am over 18 years of age and consent to the agreement and procedure, or have a parent that consents to the procedure. This agreement will remain in effect for this procedure and all future procedures conducted by my Esthetician. By signing below, I verify that I have read and fully understand the above statements and agree to them.

  • Date of signature *
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