Eyebrow Tint Consultation and Waiver Form

  • Client Consultation Form

  • Personal/Medical History Form

    To ensure you receive the safest and most effective eyebrow tint treatment, please complete the following questionnaire accurately. All information provided will be kept strictly confidential.

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you hear about us*

  • Medical History

  • Are you pregnant or breastfeeding?*
  • Do you have any allergies to hair dye, semi-permanent makeup, or any cosmetic ingredients?*
  • Do you have any skin conditions (eczema, psoriasis, dermatitis) near the brow area?*
  • Do you have sensitive skin or a history of allergic reactions to beauty treatments?*
  • Have you experienced any reactions to eyebrow tint or hair dye in the past?*
  • Do you have any eye infections or irritation currently?*
  • Are you currently taking any medications or using topical products that might increase skin sensitivity?*
  • Do you have any chronic illnesses or immune system disorders?*
  • Have you had recent chemical peels, laser treatments, or other facial procedures in the brow area?*
  • Do you have any other concerns or conditions the technician should be aware of?*
  • Do you currently use Retin-A, Accutane or similar?*
  • Do you currently have (check any that apply):*
  • Are you currently under the care of a physician for any condition?*

  • EYEBROW TINT CONTRAINDICATIONS

  • A contraindication is a condition that makes the client unfit or at increased risk for this treatment. Please consult with your technician before the procedure if you have any of the following:

    Not Recommended for Clients Who Are or Have:

    • Pregnant or breastfeeding (consult your healthcare provider)
    • Recent skin trauma, cuts, abrasions, burns, or swelling in the eyebrow area
    • Skin disorders affecting the brow area (eczema, psoriasis, dermatitis, or other inflammatory skin conditions)
    • Known allergies or sensitivities to hair dyes, semi-permanent makeup pigments, or related chemicals
    • Eye infections or irritation near the eyebrow area (conjunctivitis, blepharitis, styes)
    • Recent facial surgery, chemical peels, laser treatments, or other cosmetic procedures in the brow area
    • Hypersensitive or reactive skin in the eyebrow region
    • Autoimmune disorders affecting the skin (consult your technician)
    • Use of photosensitizing medications that increase sensitivity to dyes or chemicals
    • History of allergic reactions to eyebrow tint or hair dyes

    Contraindications & Special Care:

    • Skin conditions causing excessive dryness or flaking around the brow area
    • Contact dermatitis or rash in or near the treatment area
    • Use of topical or oral retinoids or exfoliating products on or near the brow area within 14 days before treatment

    Additional Considerations:

    • If you wear contact lenses, please remove them before the procedure to avoid irritation.
    • If you have hay fever or watery eyes, please notify the technician as this may affect treatment comfort.


    Please disclose any other medical conditions or concerns to your technician before the procedure. The technician reserves the right to decline treatment if it is deemed unsafe or unsuitable.

  • AFTERCARE

  • EYEBROW TINT AFTERCARE INSTRUCTIONS
    To ensure optimal results and minimize the risk of irritation or complications, please carefully follow the aftercare instructions below:

    • Avoid getting your eyebrows wet for at least 24 hours after the tinting procedure.
    • Do not apply makeup, creams, or skincare products directly on the eyebrow area for 24 hours.
    • Avoid excessive sweating, saunas, and swimming for 24–48 hours to prolong the tint’s longevity.
    • Avoid rubbing, scratching, or exfoliating the eyebrow area.
    • Avoid using oil-based products on or near the brows as they can cause the tint to fade faster.
    • Protect your eyebrows from prolonged sun exposure and tanning beds to prevent premature fading.
    • To maintain your tinted brows, schedule regular touch-up appointments every 4–6 weeks.

  • ACKNOWLEDGMENT

    EYEBROW TINT CONSENT FORM AND RELEASE FORM

  • Please read each statement carefully. By checking each box, you confirm that you understand and agree to the statement.

  • I,            am over the age of 18, not under the influence of drugs or alcohol, not pregnant or nursing, and wish to receive the Eyebrow Tint treatment.

  • Date*
     - -
  • Should be Empty: