New Client Consultation Form

New Client | Eyebrow Consultation Form

Please complete prior to your scheduled appointment.
Date *

Month Day Year
Name *

First Name Last Name
Date of Birth *
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
How did you hear about The Browe Bar? *

Instagram Facebook Google Yelp Online Search Referral I know Kristen I know Lilli
If Referral, please list name
Photo release - do you give permission for The Browe Bar to potentially use photos of your treatment on social media & advertising outlets? *

Yes No Maybe
About Your Eyebrows
Have you ever had your eyebrows done professionally? *

Waxed Tweezed Only Threading Eyebrow tint Eyebrow lift / lamination None of the above
Which best describes your situation? *

I am happy with my brows, & just need a clean up! I am unhappy with my brows and am looking for direction I am hoping to make my brows appear fuller I am currently growing out my brows Really nothing specific, they're just eyebrows!
Please feel free to go into more detail
About Your Skin
What is your skin type? *

Normal Combination Dry Oily Sensitive Not Sure
Have you ever had a facial or skin treatment before? *

Yes No
If Yes, when?
Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks? *

Yes No
About Your Health
Any known allergies? *

Aspirin Tree Nuts Latex Dairy Fruits Vegetables Shellfish Iodine Other None
If Other, please specify
Do you/have you used Retin-A, Renova, Adapalene, Differen, Retinol, Tretinoin, Epiduo, or other Vitamin A derivatives? *

Yes, currently using Yes, but not within the last 30 days Yes, but not within the last 6 months No Not sure
Please specify which product or type, if you answered 'Yes, currently using' to above.
Are you currently taking Accutane, or have you within the past 12 months? *

Yes, currently using Yes, but not within the last 6 months No
Please be aware topical acne medications and other skin thinning prescription medications are highly likely to cause skin to lift with the wax. Even if you are not using the product directly on the area to be waxed, it may affect ALL of your skin. This includes medication with the side effect: may cause sun sensitivity. A patch test may be performed when necessary. Clients taking Accutane are not candidates for waxing. *

I Understand
I understand, have read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive are voluntary and I release The Browe Bar from liability and assume full responsibility thereof. *

I Agree
Signature *

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New Client | Eyebrow Consultation Form

About Your Eyebrows

About Your Skin

About Your Health