Henna Eyebrows Form

Trophy Beauty By Destiny Renee

9108 Laguna Main st suite 5 Elk Grove CA 95758
Eyebrow Henna Intake Form
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Brow Henna is a organic naturally based product with over 99% of the ingredients coming from plants. No peroxides or ammonia are added to this product. Brow Henna contains Henna Plant and may contain some of the following essential oils: Cajaput, Cademom, Clove, Cypress, Eucalyptus, Lavender, Niaouli, Palma Rosa, Patchouli, Rose Geranium, and Tea Tree. Henna may include the following: Orange Juice, Lemon Juice, Sage, Wild Cherry Powder, black walnut powder, basil, nutmeg, cinnamon, indigo, cassia, buxus dioica, amla, olive oil. Coconut oil and beet powder. Brow Henna does NOT contain lead or ammonia and does not require hydrogen peroxide to activate the colour in the hair follicle.
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Current conditions, previous discomfort, stinging or adverse reaction: Please choose any that apply:

Inflammation of the eyelid/ eyebrow areaSkin trauma, swelling or abrasionsRecent operations around eye, head or face in immediate areaRecent tattooing, Microblading treatmentPrevious reaction to henna treatmentChemotherapy (current)Eye infection
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Trophy Beauty By Destiny Renee