Brow Lamination Consultation and Waiver Form

Client Consultation Form
Personal/Medical History Form

To ensure you receive the most appropriate brow lamination treatment, please complete the following questionnaire. All information provided will remain strictly confidential.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact Name*
Full Name
Emegency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about us*

FacebookInstagramGoogleFamily or Friend

BROW LAMINATION CONTRAINDICATIONS
A contraindication is a condition or factor that may make a client unsuitable for brow lamination treatment due to health risks or the possibility of adverse outcomes. Please consult with your technician before the procedure if any of the following apply to you:

Not Recommended for Clients Who Are or Have:
- Pregnant or breastfeeding (due to hormonal changes affecting hair and skin)
- Open wounds, cuts, abrasions, burns, or active skin conditions around the brow area
- Recent eye surgery or facial surgery
- Psoriasis, eczema, or dermatitis in or around the eyebrow area
- Extremely sensitive skin or a history of allergic reactions to cosmetic products
- Recent eyebrow tattooing, microblading, or permanent makeup (within the past 6–8 weeks)
- Currently using Retin-A, Accutane, or other strong exfoliants or prescription skincare in the brow area
- Any active skin infections (e.g., impetigo) or conditions such as conjunctivitis
- Recent chemical peels, laser treatments, or dermabrasion near the brows
- Severe sunburn on the face or brow area
- Brow hair loss due to alopecia or trichotillomania (discuss with technician)
- Chemotherapy or radiation therapy (consultation required)
  Bell’s Palsy or facial nerve conditions
- Any condition causing involuntary facial movements (e.g., twitching, tremors)
- Skin highly reactive to waxing or threading
Contraindications Requiring Extra Caution
- Autoimmune diseases affecting skin/hair
- Skin medications or treatments that thin or irritate the skin
- Post-chemotherapy recovery (must be medically cleared)
- Rosacea or similar chronic skin conditions near the brows
Further Contraindications for Client Comfort:
- Allergies to adhesives, tints, or perming solutions
- Use of brow serums (such as growth enhancers) – may increase skin sensitivity
Please disclose any medical conditions, allergies, or recent procedures to your technician prior to your appointment. Your safety and the effectiveness of the treatment depend on accurate and honest communication.
Acknowledgement*

I acknowledge that I have reviewed the list of health conditions and contraindications that may affect the safety and effectiveness of the Brow Lamination procedure. I have disclosed any relevant medical issues to the technician and understand that failure to do so may increase the risk of complications. I accept that the technician may refuse or postpone treatment if necessary for my safety. By checking this box, I confirm I have read, understood, and agree to these terms.

Client Consultation Form

Medical History

BROW LAMINATION CONTRAINDICATIONS

AFTERCARE

ACKNOWLEDGMENT