Brow Lamination and Tint

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

How did you hear about us?

Have you had a lash lift and/ or tint before

If yes when was your last appointment?

Date

Please select if you have any of the following conditions:

Do you have allergies to adhesives, dyes or eye products?

List allergies

Have you had any recent procedures to eyes/ face?

If yes what procedure(s)?

I agree to the following aftercare terms:

Consent and Agreement:

I certify that the information I have provided is true and accurate to the best of my knowledge and that I have disclosed any medical conditions, allergies, medications, skin conditions, or recent cosmetic procedures that may affect this service. I understand the nature of eyebrow tint and lamination services, including the potential risks, benefits, limitations, and that results may vary.

I voluntarily consent to receive eyebrow tint, eyebrow lamination, or both at Wellness at Wildwood, performed by a licensed and certified professional. I understand that I may stop the service at any time and agree to follow all aftercare instructions provided.

I release and hold harmless Wellness at Wildwood, its owners, employees, and independent contractors from liability for any adverse reactions or unsatisfactory results, except in cases of gross negligence or willful misconduct.

By signing below, I acknowledge that I have read, understood, and voluntarily agree to this consent and authorize the licensed and certified professional at Wellness at Wildwood to perform the requested service.

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