#1777312 Clone of Client Form

Client Form

General Details
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

DayMonthYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Please select if you do not wish to be added to our mailing list

Eyelash Extension Agreement Form
I have agreed to have eyelash extensions applied and/or removed from my eyelashes. Before Lash & Brow Co. can perform this procedure, I understand that I must complete this agreement and provide my consent by signing and dating this consent form where indicated.
The following conditions may determine that you are not suitable for eyelash extensions (please only select if you do have the conditions):

Allergic to adhesives (glues, tapes, band aids etc) - Eyelash extension use adhesives and gel eye pads that may cause an allergic reaction.Chemotherapy Treatment within the last 6 months - Chemotherapy Medication may cause a reaction to the materials used for eyelash extensions. Natural lashes may also be brittle and become damaged from lash extensions.Contact Lenses - Glue used to apply the eyelash extensions may get underneath the contact lenses and cause cornela abrasion or scratching. Contact lenses can be removed prior to the lash extension treatment.Eye Infection - Not only could the eye area be irritable, the infection may also spread to other clients should it be contagious.

I agree to the following:
I understand that there are risks associated with having artificial eyelash extensions applied to and/or removed from natural eyelashes.

I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the clients natural eyelashes.

I understand that a part of the procedure eye irritation, eye pain, eye itching, discomfort and in rare cases, eye infection may occur.

I understand and agree that if i experience any of these issues with my lashes that I will contact the technician and have the eyelashes removed immediately and consult a physician at my own expense.

I understand that even though the technician may apply and remove the eyelashes properly, the adhesive and/or materials may become dislodged during or after the proceudre, which may irritate the eyes or require further follow up care.

I understand that eyelash extensions will require 're-fills' on a regular basis at an additonal cost.

I understand and agree to follow the aftercare instructions provided by the technician. Failure to follow the aftercare instructions can cause the eyelash extensions to fall out and/or cause eye irritation/infection.

I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for a duration of 60-120 minutes during the procedure. I also understand that i will ned to be lying in a reclined position. Any medical conistions that might be aggavated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes.

This agreement will remain in effect for the procedure and all future procedures conducted at Lash & Brow Co. I understand that this agreement is binding and that I have read and fully understand all information listed above. I agree that I am over the age of 18 years. (If under 18 years of age, a parent or guardian must also sign this form.)
Client Name

First NameLast Name
Client Signature:

Clear
Date

DayMonthYear
Date
I agree that I am over 18 years of age
Parent/Guardian Signature (if under 18 years of age)

Clear
Date

DayMonthYear
Date
Parent/Guardian Name (if under 18 years of age)

First NameLast Name

1. The durability of microblading depends on the individuals skin texture and condition and on the skins metabolism. It is therefore not possible to guarantee durability or that the colours won’t fade. Durability depends on a number of factors: skin texture and condition, correct follow-up care by the customer, as well as choice of colour/intensity. Unwanted colour changes cannot be ruled out.

2. After the treatment, the pigmented area will appear more intense and the customer may experience swelling, redness, crusting and sensation of tightness. Please follow the care instructions for approx. 2 weeks after the treatment.

3.The result of the treatment only becomes visible once the healing process is complete; this takes approx. 2 to 4 weeks. Since we all heal differently and have different metabolisms, one or more follow-up treatments may be necessary. In some isolated cases, the desired outcome may not be achieved because sometimes the skin does not absorb the colour pigments regularly or even at all. In some rare cases, the colour may run. It is therefore not possible to guarantee a successful treatment.

4. Please protect the pigmented areas from intense UV radiation (eg: sessions at the solarium), and use our after-care cream. In the first 2 weeks, you should also avoid high levels of air moisture (eg: a sauna visit)

5. If you have had permanent make-up treatment before and we correct or re-touch it, please be aware that it is possible for the deeper and older colour to reappear after a while, or for its colour to dominate because of its chemical composition. We can therefore not guarantee the success of the treatment.

6. In rare cases, the area treated with microblading can warm up during an MRI scan. We recommend to advise your medical team that you have had such procedures done prior to commencing the scan.

7. In rare cases, allergic or allergy-like reactions can occur (granuloma, permanent skin changes, dryness, pigment disorders, sensitivity, swelling, flaking) as skin irritations as a reaction to the colour pigments. We can therefore not guarantee the tolerability of the colour pigments.

8. Microblading can only be removed by medical specialists using the latest laser technology. White colour pigments cannot be removed, and complete removal cannot be guaranteed.

9. Microblading at Lash & Brow Co. can only be performed on clients over the age of 18.

Emergency Contact Details;

Contact NameRelationship
Emergency Phone Number:

Area CodePhone Number
I confirm that I have read and understood this declaration of consent, and that I have been given the care instructions and that I will follow the instructions it contains. Colour choice and shape were discussed in detail and defined together with me. I agree to undergo microblade treatment, I have been told about the treatment process, and any risks have been fully explained to me. I undergo the treatment at my own risk.
Signed:

Clear
Date

DayMonthYear
Date

Dermaplaning is a simple, quick, and safe procedure for exfoliating the epidermis and ridding the skin of vellus hair (peach fuzz) by shaving the skin with a sterile blade; it has few to no adverse effects. Using a special and delicate touch, the therapist simply abrades the surface of the skin using light feathering strokes. It is most often used on clients with rough, dry skin, and/or superficial hyperpigmentation to enhance over all skin tone. It is a safe treatment for lients who are pregnant or nursing who want a deep exfoliation. This treatment may be reccomended to prepare the skin for a chemical peel as it allows products to penetrate more readily into the deeper layers. Results may not be seen in a single treatment. Follow-up maintenance treatments may be reccomended.

Risks and Side Effects:

Dermaplaning can create scraping, nicking and/or abrading of the skin.
Many clients are often concerned that the hair will grow back heavier and darker after dermaoplaning. This is not the case. Hair will grow back at the same rate and texture as before the treatment within 4-6 weejs.
Clients who have inflamed acne or are allergic to nickel are not ideal candidtates for this treatment.
Dermaplaning can be done as often as 2 weeks although it is usually done when the vellus hair starts to grow back which is generally in a months time.
Some patients may experience redness, irritation, dryness, post treatment acne flares, or folliculitis.
Blemishes may result after this treatment.

Immediately after treatment:

It is normal for the skin to appear red and inflamed. Light scabs may form in the treated area and remain for 24-48 hours.
Discontinue use of all topical products for 72 hours following treatment.
Use a gentle moisturiser as needed
Cleanse skin with a mild cleanser
Do not use heavt make up for the first day
Avoid excessive sun exposure and wear sunscreen daily of SPF30 or higher.
I confirm that I have read and understood this declaration of consent, and that I have been given the care instructions and that I will follow the instructions it contains. I agree to undergo dermaplaning treatment/s. I undergo the treatment at my own risk.
Signed

Clear
Date

DayMonthYear
Date

Conclusion
I agree that the information I have provided above is true and correct.I understand that the information provided is for all future treatments of the same category.I agree to notify Lash & Brow Co. of any changes that may occur in the future.
Should be Empty:

Client Form

Client Form

Eyelash Extension Agreement Form

Microblading

Brow Treatments

Aromatherapy Massage

Dermaplaning

Conclusion