BROW CONSULTATION, CONSENT & PATCH TEST FORM
YOUR DETAILS
Name:
Mobile:
Format: (000) 000-0000.
Email:
example@example.com
TREATMENT BOOKED
Treatment Options
Brow Shape & Tidy
Brow Tint & Shape
Brow Lamination (includes tint & shape)
HEALTH CHECK
Have you ever had an allergic reaction to brow, lash or tint products?
Yes
No
Do you have any allergies?
Yes
No
Are you pregnant or breastfeeding?
Yes
No
Do you have any skin conditions around the brow area?
Yes
No
Are you currently using Retinol, Retin-A or similar products?
Yes
No
Have you taken Roaccutane within the last 6 months?
Yes
No
Please provide details of any allergies, skin conditions, medications or previous reactions:
PHOTO CONSENT
May photographs be used on social media, website and marketing materials?
Yes
No
PATCH TEST RECORD
Lamination Patch Test Date:
Reaction?
Yes
No
Tint Patch Test Date:
Back
Next
Reaction? Yes / No
CONSENT & CLIENT AGREEMENT
I confirm that the information provided is accurate and complete to the best of my knowledge.
I understand the treatment process and have had the opportunity to ask questions.
I understand that results may vary between individuals.
I understand that a successful patch test does not guarantee that an allergic reaction will never occur.
I agree to inform Laura Mary MUA of any allergies, medications, medical conditions or skin sensitivities that may affect treatment.
I understand the aftercare advice that will be provided following treatment.
I consent to the treatment being carried out.
Client Signature:
Date:
-
Month
-
Day
Year
Date
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