Brow Lamination Nederland TX | Brow Tint

GENERAL INFORMATION

Full Name *

Email *

Phone Number *

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

CONSENT & ACKNOWLEDGEMENT

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 *

Client Signature Date *

Technician Signature *

Fairy - Nederland Tx

Fairy - Lumberton Tx

Business hours

Brow Lamination + Tint

Fuller, Brushed-Up Brows in Nederland & Lumberton

Book Your Brow Appointment

GENERAL INFORMATION

BROW HISTORY

MEDICAL HISTORY

CONSENT & ACKNOWLEDGEMENT

By signing below, I agree to the following:

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Business hours

Fairy - Nederland Tx

Fairy - Lumberton Tx

Fairy