Waxpro Waxbar Consent to Tint

Brow and Lash Tinting

Please answer the following questions, ALL information given today is fully confidential and is ONLY used so that your WAXPRO can provide the safest and most comfortable treatment possible.

Name*

First NameLast Name

Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date*

MonthDayYear

Phone Number*

This is my:*

E-mail*

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History:

What over-the-counter or prescription skin care products are you currently using?

Do you have Diabetes, lupus, or any auto immune disease?

YESNO

Please list any illnesses or conditions you are being treated by a physician for:

Please list any medications you are taking; including over-the-counter herbs, vitamins, and supplements:

Please list any allergies you have:

History:

	YES	NO
Have you ever used hair color before?
Have you ever had an allergic reaction to hair color?
Do you wear contacts?
Have you ever had your brows or lashes tinted before?

If you have had an adverse reaction from tinting, please explain:

Although every precaution will be made to ensure your safety and well-being, during and after your tinting application, please be aware of the possible risks below. Please read carefully.

Client Agreement:

I understand that tinting lashes or brows has some inherent risk of irratation to the orbital eye area, including the eye itself and could result in stinging or burning, blurry vision and potentially blindness should the tint enter into the eye.

I understand that if the tinting agent, developer, or mixture or both accidentally comes into contact with my eye, my eye will be flushed with water and medical attention may be required.

I understand that some irratation, itching, or burning may occur to the skin which comes in contact with the tinting agent

I understand that there may be some residual dark staining left on the skin following the tinting process of either my lashes, brows or both. This will fade and go away within a short time.

I understand that if I cancel or miss my appointment within 24-hr cancellation policy I will be charged $25.00 or HALF of the service fee, whichever is greater!

I understand that while every attempt will be made to provide me with my chosen color, everyones hair absorbs color differently and my final result may not be the color I initially wanted.

I understand that over the course of several weeks the tint will gradually lighted and fade. Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4 weeks.

I understand that if I cancel my appointment within the 24-hr cancellation policy I will be charged $25.00 or HALF of the service fee. No shows will be charged 100% of the scheduled appointment!

For the purpose of documentation, I also consent to the taking of “before” and “after” photographs.

I have read the above information and if I have any concerns, I will address these with my Waxpro. I give permission to my Waxpro to perform the tinting procedure we have discussed and waive all liabilities toward WAXPRO WAXBAR and staff from any injury or damages that may result from this treatment. I agree that this constitutes full disclosure, and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the Waxpro, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

By my electronic signature below, I agree to the Waxpro Waxbar client agreement above.

Client Signature*

Waxpro Signature