Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Have you ever had brow lamination before? *

Yes

No

Have you tinted your eyebrows in the last 6 months using henna/tint/dye? *

Yes

No

Do you have frequent eye irritation, itching or watery eyes? *

Yes

No

Have you ever had any adverse reactions or allergies? *

Yes

No

Have you microbladed in the last 6-8 weeks? *

Yes

No

You understand that you cannot use the following on your eyebrows 72 hours before your appointment: Betin-A/AHA/BHA/ and you may not exfoliate them either. *

Yes

No

Do you have any medical conditions? *

Yes

No

Are you taking any medication or supplements? *

Yes

No

Although every precaution will be taken to ensure your safety and well-being before, during, and after your brow lamination, please be aware of the following information and possible risks. Please check off: *

I understand that there are risks associated with having a brow lamination and/or tint

I understand there are risks associated with having an eyebrow tint. I further understand that as part of the procedure, skin irritation, itching, discomfort, and in very rare cases, infections could occur.

I agree that even though my technician perms the brows, & tints using the proper technique, thehigh quality products used may irritate my skin or require a physicians follow-up care.

I understand here are no guarantees for the length of time your brow lamination and/or tinting will last and grooming on a regular basis will help achieve better results. I understand post care is required.

I agree to follow all aftercare instructions, including avoiding water on brow area for at least 24 hours

I understand that while every attempt will be made to provide me with the length/ fullness I have chosen, my final result may not be what I initially envisioned.

I understand and consent to having my eyes closed for the entire duration of the procedure.

This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to treatment. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained touse. I understand the aftercare instructions and will do my part to maintain my brows. *

I agree

Patch Test *

A patch test is required for Brow Lami & Tint as an extra measure to ensure that the likelihood of you having a reaction to the treatment remains as low as possible

Yes I understand & have agreed to a patch test

Yes I understand however, I'd like to decline the patch test knowing the potential risks of the treatment

By signing below, I verify that I have read and understand the above statements and agree to them. *

First Name

Last Name

Date *

MM

DD

YYYY

Photo & Media Consent *

I give permission for my technician/therapist to take photographs and video recordings, before, during, and/or after my procedure. I give permission for my photos to be used on the company social media channels, website and used for any other marketing purpose. I further understand that there will be no financial remuneration for this.

Yes

No thank you