Phases Esthetics Brow Lamination and Tint Consent Form
Complete your client details, treatment history, and consent preferences for today’s visit.
Client Information
Full Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
New or Returning Client
*
New Client
Returning Client
Has anything changed since your last visit?
*
Yes
No
Please describe what has changed since your last visit.
*
Which brow service are you receiving today?
Brow Tint
Brow Lamination
Brow Lamination & Tint
Brow Lamination & Tint Contraindications
Brow/Facial Procedures in the Past 30 Days (Select all that apply)
*
None
Brow lamination
Brow tint
Microblading/PMU
Chemical peel
Laser/IPL
Botox around forehead/brows
Other (please specify)
Are you pregnant or breastfeeding?
*
Yes
No
Retinoid use
*
Yes
No
Accutane in last 12 months
*
Yes
No
Daily sunscreen use
*
Yes
No
Do you have any open cuts or irritation in the brow area?
*
Yes
No
Have you ever had a previous allergic reaction to brow lamination or tint products?
*
Yes
No
Photo Consent
*
Yes, I consent
No, I do not consent
Brow Lamination & Tint Risks, Contraindications & Aftercare Acknowledgment
I understand that results may vary, temporary redness or irritation may occur, allergies are possible, aftercare instructions must be followed, and I consent to treatment.
*
I acknowledge and agree
I do not agree
Full Legal Name (Electronic Signature)
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: