Brow Tint Consent Form

1
Full Name* This field is required.
First Name
Last Name
2
Your Suburb and Post Code* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Country
3
Phone Number* This field is required.
4
E-mail* This field is required.
example@example.com
5
Date of birth* This field is required.
DD/MM/YYYY
6
How did you hear about us?* This field is required.
Google
Social media
Word of mouth
Passing by
Others (Please specify...)
7
How did you hear about us? Others (Please specify...)
8
Precautions and Considerations* This field is required.1. Brow tinting will not change the shape, fullness, or texture of your brows, but it will darken and enhance their color with semi-permanent, gel-based dye. 2. Pregnancy may cause discoloration or unexpected results in tinting due to hormonal changes. 3, Skin sensitivities or allergies to tinting products may cause reactions such as redness, irritation, swelling, or itching. A patch test is recommended at least 24 hours before treatment. 4. Recently sunburnt, irritated, or broken skin in the brow area should not be tinted until fully healed. 5. Clients with very dry, thin, or sensitive skin around the brows may experience increased irritation. 6. Use of exfoliating products (AHA, BHA, retinol, etc.) or recent facial treatments may increase skin sensitivity to tinting. I confirm that I have read the precautions and considerations mentioned above and would like to proceed with brow tint service today.
YESNO
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Is this the first time you have had brow tint?* This field is required.
YESNO
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If this is not your first time getting brow tint, where and when have you had them applied?
Please type salon name and your last appointment date with them
11
Which tint colors do you prefer?* This field is required.
Black
Blue Black
Light Brown
Dark Brown
Amber
Graphite
12
Permission to use pictures* This field is required.I hereby grant my service provider the full right to take, publish, and reproduce photographs of me, my face, my brows, both before and after the procedure, for any advertising, education, or other purposes whatsoever.
YESNO
13
Waiver of liability* This field is required.1. I agree to having tint applied to my eyebrows. 2. I understand that there are rare risks associated with the procedure, such as skin irritation, allergic reaction, and discomfort. 3. I agree that if I experience any of these conditions with my brows, I will contact a professional technician and my GP to seek immediate medical attention. 4. Whilst proper techniques and procedures will be performed by the brow artist, the instruments, brushes, cleansers, and tint used may still cause irritation to my skin/brows. 5. I further agree that I will not hold Mollylash or any of its employees responsible should there be any unfavourable result. 6. I acknowledge and consent to the use of CCTV cameras with microphones in the reception area for the purposes of quality assurance and training. I understand that these recordings are used to enhance service quality and for staff training purposes. 7. Please note that no refund will be given under any circumstances.
YESNO
14
Care and maintenance* This field is required.Within 24 Hours 1. Keep your brows dry and avoid contact with water. 2. Avoid applying makeup, creams, or oils directly on the brow area. 3. After 24 hours, you may resume your normal skincare and makeup routine. General Care 1. Do not scrub or exfoliate the brow area, as this may cause the tint to fade faster. 2. Avoid prolonged sun exposure, saunas, and swimming in chlorinated water within the first 48 hours. 3. Apply a thin layer of Vaseline or nourishing oil every 2–3 days to keep the brows hydrated and maintain tint longevity. CONFIRMATION 1. I understand that brow tinting is temporary, and the tint will gradually fade after the procedure, with results lasting differently for each individual. 2. I understand that results vary depending on overall brow hair condition, skin type, and aftercare. 3. I agree to follow the maintenance instructions provided by my technician. I accept that if follow-up care is required due to my own mistake, negligence, or failure to follow these instructions, it will be at my own expense and risk.
YESNO
15
No Known Medical Conditions / Informed Consent* This field is required.I have read and completed the Client Consent Form in its entirety and in truth. I understand that I need to disclose any allergies that I may have to materials or equipment used in brow tint service. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to instructions or these warnings. This Agreement will remain in effect for this procedure, and all future procedures.
YESNO
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Signature* This field is required.I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am at least 18 years of age and that I have the right to enter this agreement.
I am over 18 years old
I am under 18 years old
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Signature of legal guardian* This field is required.I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I am under 18 years of age and I have my parent or legal guardians consent to this agreement.
Clear
18
Signature* This field is required.I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am at least 18 years of age and that I have the right to enter this agreement
Clear
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You have to agree to our terms and conditions before services can be provided to you
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