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Brow Tint/Dye and Lamination Consultation and Waiver Form
Client Information
Name
(Required)
First
Last
D.O.B
(Required)
DD slash MM slash YYYY
Phone
(Required)
Email
(Required)
Questions
Have you had any brow tinting, dyeing or lamination treatments before?
(Required)
Yes
No
Were there any reactions or issues?
(Required)
Do you have any known allergies to hair dye, cosmetics, or skincare products?
(Required)
Yes
No
Please list
(Required)
Do you have any areas of concern with the shape or thickness of your brows?
(Required)
Yes
No
Please describe
(Required)
Do you have a favourite brow look or style that you prefer?
(Required)
e.g., natural, bold, arched, straight
Do you wear makeup regularly?
(Required)
Yes
No
Do you fill in your brows?
(Required)
Yes
No
What product do you typically use?
(Required)
What color are you comfortable with for your brows?
(Required)
e.g., soft brown, medium brown, dark brown, etc.
Are you currently using any skincare products that contain active ingredients such as retinol, AHAs, BHAs, or chemical exfoliants?
(Required)
Yes
No
Please list
(Required)
Are you currently on any medications (prescription or over-the-counter) that may affect your skin?
(Required)
This includes acne treatments, blood thinners, or hormone-based medications.
Yes
No
Please list
(Required)
Do you have any pre-existing conditions such as eczema, psoriasis, or dermatitis on or near your brows?
(Required)
Yes
No
Please describe
(Required)
Have you had any cosmetic tattooing or microblading in the past 6 months?
(Required)
Yes
No
When?
(Required)
Is your skin currently dry, flaky, or oily?
(Required)
Oily or dry skin may affect the dye’s adhesion and longevity
Yes
No
Please describe
(Required)
Do you have any other concerns or expectations for your brow treatment today?
(Required)
e.g., color preference, shaping, etc.
Photo/Social Media Consent
As part of our service, we love showcasing our work on social media. We would like your permission to take photos and/or videos of your brow treatment and use them on our social media platforms and promotional materials. Your identity and privacy will always be respected, and no personal information will be shared.
Do you consent to these photos being shared on our social media platforms (Instagram, Facebook, etc.)?
(Required)
Yes
No
Patient Consent
Important Information for Clients
Brow tint/dye treatments involve the use of chemicals, which in rare cases, may cause irritation or an allergic reaction. It is strongly recommended that you inform the therapist of any known allergies, skin sensitivities, or medical conditions.
Patch tests are available upon request and should be done at least 24 hours prior to the treatment if you have sensitive skin or allergies.
The duration and intensity of the color may vary based on your skin type, hair type, and lifestyle factors such as sun exposure and use of skincare products.
Brow lamination is a chemical treatment that lifts and reshapes the brow hairs, making them appear fuller and more defined. While it is safe for most clients, it may cause irritation or an allergic reaction in rare cases. Please inform your therapist of any allergies, sensitivities, or medical conditions.
A patch test is available upon request and should be done at least 24 hours before the treatment if you have sensitive skin or allergies.
Aftercare is crucial for maintaining the results of your lamination. Avoid wetting the brows for at least 24 hours and follow the recommended aftercare routine provided by your therapist.
Client Waiver and Agreement
(Required)
I acknowledge that I have disclosed all known allergies, medications, and skin sensitivities to my therapist. I understand that brow tint/dye treatments involve the use of chemicals that may cause irritation or an allergic reaction. Should any irritation, allergic reaction, or undesirable result occur due to information not disclosed during this consultation, I understand that the therapist is not liable.
Additionally, I agree to follow the aftercare advice provided by my therapist to ensure the best possible results from my treatment.
By signing this form, I consent to receiving the brow tint/dye treatment and waive any claims of liability against my therapist or the salon for reactions or complications resulting from omitted information.
I agree
Name
(Required)
First
Last
Date
DD slash MM slash YYYY
Signature
(Required)
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