Brow Lamination & Lash Lift Intake + Consent Form

Brow Lamination & Lash Lift Intake + Consent Form
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Emergency Contact*

NamePhone Number
Medical History & Screening
Please check all that apply:*

Eye infections, conjunctivitis, or styes (past 6 months)Recent eye surgery or injurySkin conditions around eyes/brows (eczema, psoriasis, dermatitis)Sensitivity to adhesives, tints, perming solutions, or hair dyePregnant or breastfeedingUse of Retin-A, Accutane, or skin-thinning medicationsRecent Botox, fillers, or chemical peels (within 2 weeks)None of the above
If any apply, please consult your provider before treatment.
Treatment Information

Brow lamination and lash lift involve applying chemical solutions to the brow hairs or lashes to temporarily restructure and set them into a desired shape. Tint may also be applied for enhanced color.
Possible Risks & Side Effects

Although extremely rare , understand that possible risks include but are not limited to:
- Temporary redness, swelling, or irritation around eyes/brows
- Dryness, brittleness, of brow hairs/lashes
- Allergic reaction to solution or tint
- Uneven results depending on natural hair growth patterns
- In rare cases, eye injury if solution enters the eye
Contraindications

I understand that I should not undergo brow lamination or lash lift if:
- I have active eye infections, cuts, or sores near the area
- I have had an allergic reaction to tint, perming, or lamination solutions before
- I am undergoing chemotherapy or radiation
- I have extremely short, weak, or brittle lashes/brows
Pre-Treatment Guidelines
I agree to:*

Arrive without makeup, mascara, or brow productsAvoid waterproof mascara for at least 48 hours beforeDiscontinue use of lash serums 24 hours prior
Post-Treatment Guidelines

I understand that after my service I should:
- Avoid getting brows/lashes wet for 24 hours (no swimming, steam, or saunas)
- Avoid rubbing, picking, or applying makeup directly to the area for 24 hours
- Use nourishing oils/conditioners as recommended
- Avoid strong cleansers, exfoliants, or retinoids near the area for 48 hours
- Brush brows/lashes daily to maintain desired look
Photo Consent
Do you consent to before/after photos?*

YesNo
Acknowledgement and Consent
I confirm that:*

I have disclosed all medical conditions and allergies.I understand the nature of the procedure, risks, and aftercare instructions.I understand results vary based on my natural hair growth and condition.I release my provider from liability for any adverse reactions.
Client Name*
Client Signature (If under 18 signature of parent or guardian)*
Date*

MonthDayYear
Should be Empty:

Brow Lamination & Lash Lift Intake + Consent Form

Medical History & Screening

Treatment Information

Possible Risks & Side Effects

Contraindications

Pre-Treatment Guidelines

Post-Treatment Guidelines

Photo Consent

Acknowledgement and Consent