Eyebrow Lamination Consent Form
Please complete this form to provide your consent and health information prior to your eyebrow lamination treatment.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Have you ever had an allergic reaction to any cosmetic products?
*
Yes
No
Do you have any of the following conditions? (Select all that apply)
*
Sensitive skin
Eczema or dermatitis
Open cuts or wounds near eyebrows
Currently pregnant or breastfeeding
None of the above
Other
Are you currently using any topical creams or treatments on your eyebrows or surrounding area?
*
Yes
No
Please list any medications you are currently taking (including over-the-counter and supplements):
I have received and understand the aftercare instructions for eyebrow lamination.
*
Yes, I have received and understand the instructions.
No, I need further explanation.
Additional Notes or Questions (optional)
Client Signature (Please sign below to provide your consent)
*
Submit Consent
Submit Consent
Should be Empty: