Brow Lamination Intake Consent Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Do you have sensitive skin?
*
Yes
No
Have you recently have any facial treatment, peels, microdermabration, dermaplaning or skin microneedling?
*
Yes
No
Are you currently using any acne medications like Accutane, Retin A or skin products with Alpha hydroxyl (AHA) or any other skin thinning medications?
*
Yes
No
If you have answered YES to the questions above, please ensure you have stopped using these products at least 5 days prior to your brow appointment?
*
Yes, I will stop products at least 5 days prior to my appointment.
Are you currently pregnant or breastfeeding?
*
Yes
No
Do you have any known allergies to PPD (ingredient found in most hair-dyes and brow tints)
*
Yes
No
Have you ever had your eyebrows tinted?
*
Yes
No
Have you recently or ever had your eyebrows "tattooed" or microbladed?
*
Yes
No
Have you had a spray tan or increased sun exposure, sunburn in the last week?
*
Yes
No
I consent to have pictures taken of me, and allow the photos to be used for Sola.Sets media and marketing purposes.
*
Yes
I understand that I need to follow proper aftercare guidelines to achieve maximum results.
*
Yes, I understand.
I understand that the results are not guaranteed and will vary person to person and the state of my natural brows will factor into my results.
*
Yes, I understand.
I understand that this procedure will result in a semi-permanent change in the structure of my eyebrows. If the services I choose included brow tint, I understand that my eyebrows will be stained a different colour which will last for a few days up to a week on the skin.
*
Yes, I understand.
I understand that I may develop a reaction at any point during or after the brow service from the products used during my service. I accept that such risk is possible. In the event where I develop a reaction during my service, I understand that my service may not be completed to ensure my safety. If I suspect a reaction arising post procedure, I will contact Gabriella o/a Sola.Sets within 48 hours post-service.
*
Yes, I understand.
I understand that waxing will ge apart of the procedure and that using certain products can increase the risk of injury to my skin. I consent to getting the waxing treatment and I have made my artist aware if I am currently using any products such as Retin-A, Accutane, products with alpha hydroxyl (AHA) and any other skin thinning treatments.
*
Yes, I understand and I give my consent.
I indemnify and hold harmless Sola.Sets against any claims, expenses, damages, and liabilities.
*
Yes
I confirm that the information I provided in this document is accurate and true.
*
Yes, I confirm.
Client's Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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