Intake form
Please fill out to the best of your ability.
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Emergency contact
First Name
Last Name
Emergency contact number
Please enter a valid phone number.
Format: (000) 000-0000.
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Booked appointment(s)
Brow Bundle
Brow lamination
Brow stain
Brow wax
Have you had your brows professionally done before?
Yes
No
Have you previously had:
Brow lamination
Brow tint
Brow wax
Henna
Permanent makeup
Have you experienced an allergic reaction to any of the following:
Hair dye
Eyebrow tint
Wax
Adhesives
Latex
None
Do you currently have any of the following:
Sunburn
Open cuts
Rash
Eczema
Psoriasis
Cold sores
Skin infection
Active acne around brows
None
Are you currently using or recently used:
Accutane (within last 6 months)
Prescription retinoids
Retinol
Tretinoin
Adapalene
Glycolic acid
Benzoyl peroxide
Chemical peel (within last 2 weeks)
Laser treatment (past month)
None
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Client Consent
I understand results vary depending on my natural brow hair. I understand redness after waxing is normal. I understand tint/stain fades over time. I understand brow lamination lasts approximately 6–8 weeks. I understand an allergic reaction may occur even if I have had previous treatments. I agree to disclose all medications and skin conditions. I understand aftercare instructions are important for the longevity of my results. I understand no guarantees or refunds are offered once my service has been completed. I consent to photographs.
Signature
Todays Date
-
Month
-
Day
Year
Date
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