New Client | Eyebrow Consultation Form
Please complete prior to your scheduled appointment.
Date
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Month
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Day
Year
Date Picker Icon
Name
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First Name
Last Name
Date of Birth
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
E-mail
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How did you hear about The Browe Bar?
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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?
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Yes
No
Maybe
About Your Brows & Lashes
Have you ever had your eyebrows done professionally?
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Waxed
Tweezed Only
Threading
Eyebrow tint
Eyebrow lift / lamination
None of the above
Have you ever had any of the following done on your lashes?
Eyelash Extensions
Lash Lift
Eyelash Tinting
None of the Above
Which best describes your situation?
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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?
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Normal
Combination
Dry
Oily
Sensitive
Not Sure
Have you ever had a facial or skin treatment before?
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Yes
No
If Yes, when?
Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?
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Yes
No
About Your Health
Any known allergies?
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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?
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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?
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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.
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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.
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I Agree
Signature
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