Hello ! Welcome to Brow Baddie Lyd
This form is to ensure we have full consent !
General Facials
This is for all facial services performed by The Brow Baddie !
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I
Name
provide awareness to the following below.
I am aware that there are side effects to facial treatments including, but are not limited to, peeling, cracking, flaking, skin allergies, swelling or bumps.
Please Select
yes
no
I confirm that all reactions, sensitivities, and hazards have been disclosed to me, and I have been given the opportunity to ask questions.
Please Select
yes
no
l assume full responsibility for any possible dangers, reactions, and sensitivities, and I have informed my provider of any allergies.
Please Select
yes
no
I understand and agree that I will call my provider promptly if I suffer an adverse response. I am aware that I may be required to seek medical care at my own expense.
Please Select
Yes
No
I will not hold my provider accountable for any responses, sensitivities, or injuries that may arise from this treatment.
Please Select
Yes
No
I understand that my provider has the right to refuse for all waxing treatment services as my provider sees fit. Proper hygiene must be followed and I will let my provider know if I am currently menstruating.
Please Select
Yes
No
I am over the age of 18 or I have parental consent co-signed below.
Please Select
yes
no
If you are under age requirements, you have contacted your guardian to ensure that it is appropriate and acceptable to provide treatment today or with future appointments.
Please Select
Yes
No
By signing below, I herby acknowledge that I have completely read and fully understand the above agreement.
Signature
Date
-
Month
-
Day
Year
Date
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Consultation Form
This helps get a clear understanding of your skins needs!
Choose your skin type
Dry
Oily
Combination
Sensitive
Sun exposure ( burn wise)
Never
Light
Moderate
Excessive
How does your skin heal?
Slow
Fast
Scars
Pigment
Do you use Acne products?
Please Select
Yes
No
If so what kind
List your top skincare products
Medical History
Acne
Arthritis
Asthma
Blood disorder
Cancer
Diabetes
Eczema
Epilepsy
Fever blisters
Heart condition
Herpes
Hepatitis
High Bp
HIV/AIDS
Hyper pigmentation
Hypo pigmentation
Hysterectomy
Low Bp
Skin Disease
Lupus
Other
Biggest skin concern.
Any allergies?
Pregnant or breastfeeding?
Please Select
Yes
No
Have you used any harsh active ingredient skincare within the past two weeks ? ( retinol, AHA OR BHA )
Please Select
Yes
No
By signing below, I herby acknowledge that I have completely read and fully understand the above agreement.
Signature
Continue
Continue
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