Client Consultation, Consent & Waiver Form
Complete your details, select your service, answer relevant safety questions, and review consent & aftercare before signing.
Client Information & Appointment
Client Name
*
First Name
Middle Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Appointment Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Service Selection
*
Please Select
Lash extensions
Lash lift & tint
Korean lash lift & tint
Brow lamination & stain
Brow waxing
Brow lamination
Brow stain
Service-Specific Consultation
Select the service you want to discuss
Do you have any known allergies or previous reactions to lash adhesive, tint, stain, lamination products, or wax?
*
No
Yes
Not sure
Are you currently taking any medications or using skincare products that may affect this service, including Accutane/isotretinoin, retinol, tretinoin, or chemical exfoliants?
*
No
Yes
Not sure
Do you have any skin or eye irritation, infection, sunburn, peeling, wounds, or unusual sensitivity in the treatment area?
*
No
Yes
Not sure
Have you had any recent facials, chemical peels, laser treatments, or other skin treatments that may affect today’s service?
No
Yes
Not sure
Have you had Botox, filler, or an eye procedure recently that may affect this service?
No
Yes
Not sure
Have you had recent lash or brow treatments, such as extensions, tinting, staining, lifting, lamination, waxing, or shaping?
No
Yes
Not sure
If yes, please describe the treatment, product, reaction, and when it occurred
For brow waxing: Are you using Accutane/isotretinoin, or do you have fragile, peeling, or overly sensitive skin that may require postponing the service?
No
Yes
Not applicable
Please share any other safety concerns or details relevant to the selected service
Consent, Acknowledgment & Aftercare
I understand the procedure may cause temporary irritation, redness, swelling, sensitivity, or allergic reactions, and results may vary.
*
Yes, I understand
The information I have provided is true, complete, and accurate to the best of my knowledge.
*
Yes, I understand
I understand BBz Beauty Studio may use my photos and videos for social media and other promotional purposes.
*
Yes, I understand
Electronic Signature
*
Photo Release
Submit
Submit
Should be Empty: