Brow Lamination Consent Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any allergies (especially to perming solutions, adhesives, hair dye, or skincare products)?
Yes
No
Have you ever experienced a reaction to eyelash extensions, lash lifts, strip lashes, brow laminations, or tinting?
Yes
No
Do you have sensitive eyes or skin?
Yes
No
Do you have or have had any eye conditions (conjunctivitis, blepharitis, styes, dry eyes, glaucoma, recent eye surgery, watery eyes, seasonal allergies)?
Yes
No
If yes, please specify below.
Are you pregnant or breast feeding?
Yes
No
Do you wear contact lenses? (If yes, do you understand they must be removed before a lash lift)?
Yes
No
Have you had recent procedures in the eye/brow area (Botox, fillers, microblading, chemical peels, surgery, ect.)?
Type option 1
Type option 2
Type option 3
Type option 4
Are you currently taking any medication that may affect your skin or hair growth (Accutane, steroids, chemotherapy, thyroid medication, ect.)?
Type option 1
Type option 2
Type option 3
Type option 4
Consent & Liability
Have you had a brow lamination or lash lift before?
Yes
No
If so, did you have any reactions or experience any issues?
Do you understand that reactions (redness, itching, swelling, irritation) may occur?
Yes
No
Do you release the technician from liability for reactions due to undisclosed conditions or failure to follow aftercare?
Yes
No
Do you understand that results are not permanent and maintenance appointments will be needed?
Yes
No
Do you give consent for before and after photos (for records/marketing purposes)?
Yes
No
Signature
Continue
Continue
Should be Empty: