LASH & BROW CONSULTATION & CONSENT FORM
Please complete this form to help us provide a safe and personalized Lash & Brow Consultation experience. Your information will remain confidential.
Client Information
Please provide your personal and contact details.
Full Name
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First Name
Last Name
Email
*
Phone Number
*
Format: (000) 000-0000.
Date
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Month
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Day
Year
HEALTH & SAFETY SCREENING
Please answer the following:
Do you have any known allergies or sensitivities to lash, brow, wax, tint, or skincare products?
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No
Yes
Details
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Do you currently have any eye irritation, redness, infection, swelling, stye, or recent eye procedure?
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No
Yes
Details
*
Are you using Retinol, Accutane, acne medication, or strong exfoliating products near the brow area?
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No
Yes
Details
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Have you had any recent lash or brow treatment in the past 2–4 weeks?
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No
Yes
Details
*
Are you pregnant, breastfeeding, or taking any medication that may affect your skin, hair, or sensitivity?
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No
Yes
Details
*
CLIENT CONSENT
Consent
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I confirm that the information above is accurate to the best of my knowledge. I understand that lash and brow services may cause temporary redness, irritation, or sensitivity. I agree to inform the provider of any allergy, medication, eye condition, skin condition, or discomfort before service. I understand that service may be modified, postponed, or declined if it is not safe to proceed.
Client Signature
*
Date Signed (Client)
*
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Month
-
Day
Year
Date
Submit Consultation & Consent
Submit Consultation & Consent
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