Brow Consultation and Consent Form New Clients
Please fill out this form to help me understand your preferences and ensure a safe and satisfactory service.
Full Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Name & Contact Mobile
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Health
Please select any that apply to you
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Latex
PPD Allergy
Essential Oils
Fragrance / Perfume
Dry Eyes
Artificial Colorants
Dyes or Artificial Colorants
Aloe Vera
Botanical Extracts
Pollen or Dust Allergy/Sensitivity
Heat or Cold Sensitivity
Adhesives
Preservatives
Other
None
If other please provide further detail.
Please select any that apply to you
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Skin Infection
Diabetes
Recent Sunburn
Eczema
Rosacea
Active Acne
Open Lessions
Allergic Contact Dermatitis
Rashes or Inflammation
Bruising
Recent Chemical Peel
Laser / Post-Laser
Botox or Fillers
Use Of Topical Ingredients (Retinol, benzoyl peroxide, etc.)
Alpha Hydroxy Acids (AHAs), Beta Hydroxy Acids, (BHAs), or exfoliants.
Accutane within the last 6-12 months
Thyroid
Hormonal Imbalance
Bleeding Disorders
Autoimmune Conditions
Epilepsy or Seizures
Pregnancy
Other
None
Please describe any allergies, skin sensitivities, or medical conditions relevant to brow waxing or tinting.
Brow Goals
What are your brow goals?
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Bolder
Fuller
Deeper
Natural Looking
Fill Uneven Areas
Balance
Fill Patchy Areas
Darken
Softer
Low Maintenance
Reduce Daily Makeup
Maintain Color In Between Lamination
Fluffy & Full
Achieve Longer-Lasting Results
Match or Complement Hair Color
Other
Please describe in detail your brow goals or what you would like to achieve for your brows.
Please describe to me what your brows look like without any makeup or product on.
Please describe to me what your brows look like when you style, pencil, fill, tint, or color them when doing your makeup.
Please feel free to provide a photo of how you style your brows day to day.
Browse Files
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Do you have any specific preferences or concerns regarding brow waxing or tinting?
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Yes, I have specific preferences
No, I am open to recommendations
Undecided
Is there any other information you’d like for me to be aware of prior to your appointment to provide you the best experience possible?
Would you prefer your appointment to be silent?
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Yes, I would like my appointment to be silent.
No, I don’t want my appointment to be silent.
Undecided
Brow Wax & Tint/Stain Aftercare: I understand that I must be gentle with my brows. Avoid rubbing, pulling, or applying pressure. My brows should remain dry for the first 24 hours after treatment. Use of steam, sauna, or swimming may be resumed after 24 hours but may reduce the longevity. I agree to avoid sleeping on my face or the side of my face possible effecting my tint/stain. I agree to avoid harsh products, oil-based cleansers or makeup, exfoliation, active ingredient, or harsh ingredients that can affect my tint/stain color. I agree to brush and moisturize them daily morning and night to help maintain the color and shape of my brows.
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I understand
Other
I understand that I must discontinue the use of any active skincare ingredients. Including Vitamin A, retinols, exfoliants, AHAs, BHAs, or other topical treatments at least 24–48 hours prior to my appointment to prevent irritation or adverse reactions.
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I understand
Other
I understand that, while every attempt will be made to provide me with my custom color, everyone’s hair and skin absorbs color differently and my final results may not be the color I initially wanted.
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I understand
Other
I understand that over the course of 7-14 days the tint will gradually lighten and fade on the skin. Tint results vary 2-4 weeks on physical brow hair. Re-tinting will be required to keep the new color fresh.
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I understand
Other
I hereby grant the above mentioned salon the right to use and publish photographs taken of me during my appointment for marketing, promotional and other business purposes. I understand these images may be used in print, digital media, or online platforms. I waive any right to inspect or approve the finished product and acknowledge that I am not entitled to any compensation for the use of these images. I release the above mentioned salon from all claims and liability relating to said photographs.
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Yes
Other
Reservation & Cancellation Policy for all current and future appointments: In the event of cancellations received less than 24 hours prior to appointment a cancellation fee equal to the reserved service booking will incur. No Shows will be charged 50% of the service booked. As well as non refundable deposit. If running 15 minutes late or more, appointment may be cancelled.
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I understand
Other
By signing below, I acknowledge and agree to follow all brow wax & tint/stain care and maintenance instructions to ensure the best results and longevity of my treatment. This agreement remains valid for this and all future brow wax & tint/staining services performed by my technician. I have read and understand all information provided, and I agree to communicate any questions or concerns directly with my technician. I give Allyson Johnson permission to perform brow wax & tint/staining procedure.I confirm that I have answered all questions truthfully, including disclosing any allergies, medications, or products I currently use. I understand that every precaution will be taken to minimize risk, but no results can be guaranteed. I acknowledge that this form serves as full disclosure and replaces any previous verbal or written agreements. I certify that I have had the opportunity to ask questions, understand the procedure and its risks, and consent to proceed with the treatment at my own discretion.
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I understand
Other
I confirm that the information I’ve provided in this form is complete and accurate to the best of my knowledge. I understand that this information is essential for my esthetician to provide safe and effective treatments and that it replaces any previous verbal or written disclosures for future treatments and services. I acknowledge that withholding or providing incorrect information may lead to unwanted skin reactions or contraindications during or after treatment. I understand that temporary redness, sensitivity, or other mild reactions can occur following the services. I agree to communicate immediately with my esthetician if I experience any discomfort during my treatment so that adjustments can be made. I acknowledge that all services received are voluntary, and I release the esthetician from any liability and assume full responsibility for my participation and results.
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I understand
Other
Signature
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Submit
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