CONSENT SERVICES FORM Brow Lamination + Tint - [lumbertan]

REWRITE FORM

Brow Lamination + Tint (lumbertan)

CONSENT SERVICES FORM

Brow Lamination + Tint

GENERAL INFORMATION

Full Name

Phone Number

Email

Address

BROW HISTORY

Have you ever had your brows laminated?

Yes

No

If yes, have you ever had an adverse reaction?

If yes, please explain

Have you ever had an allergic reaction to hair perming products?

Yes

No

If yes, please explain

Are your brows micro bladed or ombre powdered?

Yes

No

If yes, when did you get them done?

Are you currently using any skin care or exfoliating products around the eyebrows with any of the following ingredients,Retina A,Glycolic Acid,Salicylic Acid,Alpha Hydroxy Products,Cortisone or Acne Products?

Yes

No

Have you recently bleached or tinted your eyebrows?

Yes

No

If yes, when did you get them done?

MEDICAL HISTORY

Are you pregnant or nursing?

Yes

No

Are you currently taking any medications?

Yes

No

If yes, please list:

Are you currently using Retinol around the eyebrows or taking Accutane or similar medications?

Yes

No

Do you have any of the following conditions? Eczema or Psoriasis around the Eyes, Recent Eye Surgery, Recent Eye Infection, Recent Chemical Peel, Sensitive Skin , Sunburn

Yes

No

Although every precaution will be taken to ensure my safety and wellbeing before, during, and after the brow lamination process, I am aware of the following information and possible risks. Please initial:

I understand that during the treatment, despite all precautionary measures, injury is possible and I will not hold the technician or business performing this service on me responsible in any way for any damages or issues that may arise as a result of having the brow lamination and tint procedure performed on me.

I understand that some irritation, itching or burning may occur on the skin which comes in contact with the lamination agent.

I understand that an allergic reaction is possible and if any allergic reactions may occur, I am to seek medical attention or speak to a doctor immediately.

I understand that it is imperative that I disclose all of the information required on the Client Consent Form.

I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.

I consent to “before and after” photos for purpose of documentation, potential advertising and promotional purposes.

I agree that if I experience any ill effects with my brows, I will contact the technician that performed this procedure.

I am aware that brow lamination lasts 4-8 weeks depending on aftercare immediately after procedure + throughout the weeks is based solely on myself.

I understand that I need to keep my eyebrows free of water for 24 hours after the brow lamination.

I understand that I have bypassed the patch test option that was available for lamination and tint.

I understand I need to wait 6-8 weeks

I understand I need to wait 6-8 weeks between getting brow lamination

I agree there are no refunds

By signing below, I agree to the following:

I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that i do not have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician and the salon for any injury or damages incurred due to any misrepresentation of my health. This agreement will remain in effect for this procedure and all future follow-ups conducted by the technician. I understand that this consent agreement is legal and binding. 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 the brow lamination and tint procedure, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement, and his or her relationship to me is as follows:

Client Signature

Sign Here

Client Signature Date

Technician Signature