Brows By Mak
Consent Form
Client Full Name
*
First Name
Last Name
Date of birth
*
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency contact name & number
*
Are you currently or recently stopped taking any medications?
*
Do you AGREE to let me know when you become pregnant for health & safety reasons with treatments. This will be kept confidential but is a necessity for me to know
*
Yes
Do you have any allergies or skin conditions I should be aware of?
*
Have you used roaccutane or something similar to treat acne in the last 12 months. If so, when was the last time you used it?
*
Have you ever experienced a reaction in a beauty salon before. If so, what was the treatment & how did you react?
*
Do you AGREE to advise your beauty therapist if you have had surgery, chemical peel, laser treatment, injectables, sun exposure or tattooing in the last 14 days before your scheduled appointment
*
Yes
Do you AGREE to patch testing if required for a treatment?
*
Yes
Do you consent to photos, videos being taken during treatments?
*
Business records only
Social media
Website
All of the above
No photos or videos
UNDER 18- I have gained consent from my parent or guardian that I am able to attend my appt
*
Yes
N/A - I am over 18
I AGREE that I will reschedule my appt if I am sick or feeling unwell
*
Yes
* I acknowledge that:
*
I have answered all questions honestly and disclosed all relevant medical conditions, medications, allergies and previous reactions and will continue to update my beauty therapist if these details change
I understand that withholding information may increase the risk of adverse reactions or unsatisfactory results and may result in being denied a future appointment
I understand that treatment outcomes cannot be guaranteed
I will follow all before and aftercare instructions provided
I understand that if I fail to disclose relevant medical information, allergies, medications, or conditions, the salon and therapist cannot be held responsible for any resulting reactions, complications, or adverse outcomes.
I understand that some services may require a patch test and that proceeding without one may increase the risk of an allergic reaction
I understand that is a requirement to let my therapist know if I am currently pregnant or planning to become pregnant to avoid risks with treatments & that this will be kept completely confidential between me & my therapist
I have read and understood this form and have had the opportunity to ask questions
*
Yes
Client Signature
*
Today’s Date
*
Submit
Submit
Should be Empty: