Brow Intake Form

Brow Tinting & Lamination Client Intake Form

Full Name

Address

- Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Emergency Name

Emergency - Phone Number

Format: (000) 000-0000.

Medical History

If any conditions checked please explain

List any known allergies including medications plants dyes etc

Are you currently using any of the the Following?

If yes any reactions or concerns

Have you ever had brow tinting, henna brows, or brow lamination before?

Date of last brow service (if applicable):

I, the undersigned, acknowledge and understand the following:

The brow tint and/or brow lamination process involves the application of chemical products directly to the eyebrow area.

There are potential risks such as skin irritation, allergic reactions, or eye sensitivity. A patch test is recommended at least 24-48 hours prior to the appointment to minimize risk of adverse reaction.

Consent to a patch test.

Decline a patch test and accept full responsibility.

It is my responsibility to inform Allure Skin & Beauty LLC of any changes to my health, skin condition, or medications before services are performed.

Allure Skin & Beauty LLC and its employees are not liable for any allergic reactions or complications due to undisclosed medical information or refusal of a patch test. Results of services may vary based on individual skin and hair type, and no guarantees are made.

By signing below, I acknowledge that I have read, understood, and agree to the terms above.

Signature

**For Office Use Only** - Patch Test Conducted: [] Yes [ ] No - Reaction Observed:

Reaction Observed

Technician Notes