Eyebrow Lamination Consultation and Consent Form

Client Details

Full Name: *

Date of Birth: *

Email: *

Contact Number: *

Medical History

Are you currently taking any medication? *

Please list: *

Do you have any allergies or intolerances? *

Please list: *

Do you have/use any of the following? Please tick all that apply.

Do you have any other medical conditions? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone: *

Aftercare Advice

Do not touch the area for 24 hours.
Do not apply any products to the area for 24 hours.
Do not get your eyebrows wet for the first 24 hours.
No extreme heat treatments (e.g. very hot baths or showers, saunas, steam rooms), swimming, sunbathing (including sun beds or any other exposure to UV light) for 24 hours. Avoid exercise or anything that makes you sweat for 24 hours.
Do not pluck or tweeze in-between appointments, particularly in areas where your therapist has advised re-growth.

Important Note: Self-tanning products may alter tint colour, so we recommend using these with caution on your face in between tinting treatments. We do not recommend that you attend any brow appointments which include a tint with any self-tanning products on your face.

Please inform us immediately if you experience any problems after your treatment, including prolonged swelling, an itchy rash, bruising, or any kind of skin grazing, cuts or tearing so that we can advise the correct treatment. In the unlikely event that your skin does not return to normal within 24 hours of your treatment, seek advice from your GP in case you have had an allergic reaction to the wax or in case an infection is developing.

Please tick the box to confirm: *

I have read and understood the aftercare advice.

Consent

Please read each statement carefully and tick to show your agreement. *

I accept that any treatment I am going to receive is at my own risk. I certify that I have read and fully understood and completed this form to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effect(s) and therefore I accept full liability/responsibility for the information given. The treatment(s) and possible side effect(s) have been fully explained to me. I accept full responsibility for the treatment given and complications which may arise or result during or following any procedure that is performed at my request. I accept that if I am not satisfied with the treatment I will inform the therapist and/or request to speak to the manager during or immediately following the treatment. I fully understand the above and consent to the Eyebrow Lamination treatment to be carried out.

Client Signature: *

Tap or click on the signature above to sign