Brow Lamination Consent Form

Brow Lamination Consent Form

Client Information
Name

First NameLast Name
Preferred Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Birthdate

MonthDayYear
Date

Consent
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 read and agree to the following:
- I understand that during the treatment, despite all precautionary measures, injury is possible 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 procedure performed on me.
- I understand that some irritation, itching or burning may occur to the skin which comes in contact with the lamination agent.
- I understand that an allergic reaction is possible.
- I understand that it is imperative that I disclose all of the information requested on the Client Intake 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” photographs for the purpose of documentation, potential advertising and promotional purposes.
- I agree that if I experience any ill effects with brows that I will contact the technician that performed this procedure.
- I understand that brow lamination is the process of restructuring the brow hairs to keep them in a desired shape, but it is my responsibility to brush my brows daily to maintain the desired look.
- I understand that I need to keep my eyebrows dry for 48 hours after the brow lamination process.
- I understand that brow lamination is not recommended for people with following, and I hereby certify that none of the below apply to me:
  - Alopecia
  - Conjunctivitis
  - Currently taking blood thinners, brow growth serum, retinol, Accutane, or AHAs or BHAs
  - Eczema
  - Pregnant/breastfeeding
  - Psoriasis
  - Recent eye surgery
  - Recent microblading
  - Retinol
  - Sensitive skin
  - Scar tissue in treatment area
  - Sunburn
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 brow lamination procedure.
Date

MonthDayYear
Date
Name

First NameLast Name
Signature

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