CLIENT WAIVER FORM BROW LAMINATION & TINT/ LASH LIFT & TINT
CLIENTS NAME
*
First Name
Last Name
DATE OF BIRTH
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
AGE
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER:
*
Format: (000) 000-0000.
EMAIL:
*
example@example.com
PLEASE CHECK ALL RELEVANT BOXES:
Medical and Skin History
REACTION TO PREVIOUS BROW LAMINATION OR LASH LIFT
VERY SENSITIVE SKIN
RECENT SEMI-PERMANENT BROW PROCEDURE (WITHIN 8 WEEKS)
RECENT FACIAL (WITHIN 4 WEEKS)
ON MEDICATION FOR SKIN
SKIN ROUTINE INCLUDES USE OF AHA, BHA, RETINOL
PREGNANT OR BREASTFEEDING
I UNDERSTAND THAT:
THE BUSINESS, OWNER AND EMPLOYEES WILL NOT BE HELD RESPONSIBLE FOR ANY CLAIM OR DAMAGE THAT MAY OCCUR DUE TO BROW LAMINATION & TINT/ LASH LIFT & TINT.
INDIVIDUAL RESPONSES TO PRODUCT USED FOR LAMINATION/LASH LIFT MAY VARY - SHOULD A REACTION OCCUR, IT IS MY RESPONSIBILITY TO SEEK MEDICAL ATTENTION AT MY OWN EXPENSE.
INDIVIDUAL RESPONSES TO PRODUCTS USED FOR BROW LAMINATION/ LASH LIFT MAY VARY - THE BUSINESS, OWNER AND EMPLOYEES WILL NOT BE HELD RESPONSIBLE FOR ANY INJURY OR DAMAGE THAT MAY OCCUR DUE TO BROW LAMINATION & TINT/LASH LIFT & TINT.
I WILL ADVISE THE BROW/LASH TECHNICIAN OF ANY DISCOMFORT, IRRITATION AND/OR CONCERN IMMEDIATELY.
IT IS MY RESPONSIBILITY TO FOLLOW THE AFTERCARE INSTRUCTIONS FOR BEST RESULTS.
BROW LAMINATION/LASH LIFT WILL HAVE TO BE REDONE EVERY 4-8 WEEKS FOR MAINTENANCE. I UNDERSTAND THAT BROWS MAY BECOME UNRULY IF TOUCH-UPS ARE NOT DONE.
BROW LAMINATION WILL MAKE STYLING THE BROWS EASIER, BUT WILL NOT ELIMINATE THE NEED FOR STYLING. BRUSHING AND/OR USE OF A STYLING GEL IS STILL REQUIRED.
AS A SERVICE IS PROVIDED, THERE WILL BE NO STORE CREDITS OR REFUNDS.
CLIENT NAME/ (PRINT)
*
First Name
Last Name
CLIENT SIGNATURE
*
PARENT/GUARDIAN NAME (IF UNDER 18)
First Name
Last Name
PARENT/GUARDIAN SIGNATURE (IF UNDER 18)
DATE
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Back
Next
I AUTHORIZED THE FOLLOWING (OPTIONAL):
BEFORE AND AFTER PHOTOS/VIDEOS BE TAKEN
MY PICTURES/VIDEOS MAY BE USED FOR EDUCATIONAL OR MARKETING PURPOSES.
CLIENT NAME/ (PRINT)
First Name
Last Name
CLIENT SIGNATURE
PARENT/GUARDIAN NAME (IF UNDER 18)
First Name
Last Name
PARENT/GUARDIAN SIGNATURE (IF UNDER 18)
DATE
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: