Client Consent & Waiver Form
Review and sign to confirm you understand and agree to your brow, lash lift, and tint services before treatment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which services are you receiving today?
*
Brow Shaping/Waxing
Brow Tint
Lash Lift
Lash Tint
Do you have any allergies, skin sensitivities, or medical conditions we should be aware of?
*
Skin-Sensitizing Products & Medications
Possible risks include irritation, allergic reactions, burns, infections, over-processing, hair or lash damage, uneven results, and worsening of existing skin conditions.
Are you currently using or have you recently used any of the following?
*
Retinols
Retinoids
Accutane
Blood thinners
Acne medications
Other skin-sensitizing medications or products
Other
Please list the medications or products you use and the date(s) you last used them.
*
I acknowledge that I have informed the provider of these products or medications and understand the increased risks associated with waxing or chemical services.
*
I acknowledge
I do not acknowledge
Please confirm the following:
*
I have disclosed any allergies, sensitivities, or medical conditions.
I understand the nature and possible risks of brow, lash lift, and tint services.
I consent to receive the selected services today.
Signature (Required)
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: