Brow Lamination and Tint Consent Form

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Emergency Contact

First NameLast Name

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Address

Street Address

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Date of Birth

Date

How did you hear about us?

I have agreed to have the following procedure done today by my licensed professional, a Brow Lamination or a Brow Lamination and Tint with Waxing if necessary. By signing this form I acknowledge that I have read and understand the process and that all of my answers on this form are truthful to my knowledge. My technician has explained to me in depth the procedure and has answered any and all questions I have regarding what is to be performed.

SOCIAL MEDIA CONSENT

No

MEDICAL HISTORY | Please check any of the following that applies to you

If you checked any of the conditions above or "other" please elaborate in detail, including dates and if it has resolved.

Have you ever had Brow Lamination done before?

If yes, when was your last procedure?

If no to the question above, would you like to have a patch test performed? If so, you will need to wait at least 24 hours to see if a reaction occurs. (Note that a patch test does not guarantee that an adverse reaction will never happen, you may develop an allergy at any time)

Do you have any known allergies or sensitivities to perming solutions, neutralizers, tint solutions or products?

Have you had any surgery or injectables in the eye or brow area in the past 6 months?

If yes to the question above, please specify what was done and when:

Do you use any medications that might impact your skin health or anti-acne medications such as Roaccuataine, doxycycline and epiduogel etc

If yes to the question above, please specify:

Do you use any products containing Vitamin A, AHA’S, BHA’S, Retinols ?

If yes to the question above, when did you last use them:

Have you had any Microblading or Permanent Makeup services?

If yes to the question above, when was your procedure?

Are you currently pregnant or nursing?

Have you ever been treated for cancer? If yes, when and what types of therapies wereused?

If yes to the question above, please specify:

Have you had a chemical peel treatment or IPL/Laser treatment recently?

If yes to the question above, please specify what was done and when:

Have you had a sunburn in the past 14 days?

I, Name:* , certify that the information provided in this form is accurate
and complete to the best of my knowledge. I have read, understood, and answered all
questions truthfully. I have discussed any concerns or questions with the technician,
and I have read and understood the aftercare instructions provided to me. I agree to
inform the technician of any changes to my medical history, eye or skin conditions, or
concerns. I will not hold the salon or technician responsible for any issues not disclosed at
the time of my service or any adverse effects from the Brow Lamination, Tinting, and Waxing procedure.

Name

First NameLast Name

Date

I, Name:* , hereby consent to the procedure of a Brow Lamination and Tint or a Brow Lamination as well as facial waxing by Sublime Beauty. I understand the procedure involves the application of perming and neutralizing solutions as well as optional tint to the eyebrow hairs themselves and waxing to clean up the surrounding areas if necessary and the skin underneath.

Please note that waxing does have certain side effects such as skin removal, redness, swelling, tenderness, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the waxing procedure we have discussed and will hold her and her staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I have read and understand the post-treatment home care instructions. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

I understand that the purpose of this procedure is to soften, rearrange, and strengthen the brow hairs for cosmetic or personal reasons. I acknowledge that there are certain risks associated with this procedure, including but not limited to skin irritation, allergic reactions, and complications related to the procedure. I understand and agree that if I experience any of the above issues I will contact my technician, and if necessary consult a physician, all at my
own expense.

I release Sublime Beauty from all liability for any injury, harm, or adverse reactions claimed by me or anyone on my behalf due to the Brow Lamination and optional Tint and Wax procedure or the conduct of the licensed technician.

I understand that in order to have Brow Lamination done, I will need to keep my eyes closed for roughly 60 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my brows.

I understand that my technician has the right to refuse service if they deem my natural eyebrows are not suitable for this service or if certain health conditions may complicate the procedure.

I request and consent to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services(s).

I have been provided with information regarding the Brow Lamination and Tint procedure with Waxing, its purpose, risks, and aftercare instructions. I agree to follow the aftercare instructions provided by the technician to maintain the quality and longevity of the service. I have had the opportunity to ask questions, and all my concerns have been addressed to my satisfaction. I understand that the results of this procedure may vary depending on individual factors. I consent to the Brow Lamination and Optional Tint and Wax procedure and acknowledge that the decision to proceed with this procedure is voluntary. I understand that I can withdraw my consent at any time before the procedure begins. This agreement remains in effect for this procedure and any follow-up appointments.

Name

First NameLast Name

Date