Brow Lamination Consent Form

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Consent and Waiver for brow lamination services with dhesthetics

Email *

Client Information

General information required for liability purposes.

First & Last Name *

Phone Number *

Address *

Date of Birth (Used for special promotions😉) *

YYYY

Are you over the age of 18? *

Yes

No (parental consent needed if under 18)

Do you consent to receiving emails from dhesthetics? *

Yes

No, do not subscribe

How did you find out about dhesthetics? *

Instagram/Facebook

Google Search

Referred by a friend

Other:

General Information & Consultation

Have you had a brow lamination before? *

Yes

Other:

If so, where did you get it done? What did you like/not like about it? (This is simply used to help me understand your expectations & needs) *

When is the last time you had a brow lamination? *

Service Consent & Waiver

I understand that the brow lamination solutions will be applied to the brow hairs for a suitable, yet effective length of time thereby preserving the health, growth and texture of the clients brows. *

I understand

I understand that in order to receive brow lamination I will need to be lying in a reclined position for upwards of 60 minutes. Any medical conditions that may be aggravated by lying still for a prolonged period of time, means that I will not be able to have the procedure performed on my brows. *

I understand

I understand and agree to follow the aftercare instructions provided by Danielle (dhesthetics). Failure to follow the aftercare instructions may cause the brow lamination to not last as long as outlined & release Danielle (dhesthetics) for any damage caused by not following aftercare instructions. *

I understand

I release Danielle (dhesthetics) from all liability associated with this procedure. There are no guarantees for the length of time a brow lamination will last. I understand that I have been advised to follow the aftercare protocol from Danielle (dhesthetics) so as to avoid any discomfort or adverse side effects after the procedure has been completed. *

I understand

I agree that if any pictures are taken of my lashes/face that they may be posted to dhesthetics Instagram/Facebook or website page & that I will be tagged where/when possible. (Suitable editing will be done prior to posting) *

I consent

I do not consent

I verify that I have read and understand the above statements and fully agree to them all. *

Yes

Policy Consent

I understand that any deposit provided to dhesthetics for services is NON-REFUNDABLE. The deposit may be transferred to a new appointment time if reasonable notice is given for cancellation. *

I understand

I understand that if I no-show an appointment or cancel with less than 48 hours notice, 50% of my appointment total is due prior to re-booking. *

I understand

I understand that I must provide 48+ hours notice when rescheduling a lift & tint appointment. I understand that if I reschedule my appointment with less than 48 hours notice I will be charged a rescheduling fee of $20. *

I understand

I understand that any service rendered, completed and paid for in full by dhesthetics is NON-REFUNDABLE. *

I understand

I verify that I have read and understand the above policies and that they will apply to ALL future appointments and I agree. *

Yes

Medical Form

Do you have any allergies? PLEASE LIST ALL ALLERGIES *

Yes

Other:

Have you had any type of semi-permanent brow tattooing done within the past 6 months? *

Yes

Are you on thyroid medication? *

Yes

Do you have extremely oily skin or hair? (hyperseborrhea) *

Yes

Do you agree to discontinue use of brow growth serums 24 hours before your scheduled appointment? *

Yes

Client Consent

The information I have given on this form is correct. I have not misrepresented myself nor have I withheld any medical information, surgical state or condition. *

I affirm

Cannot affirm

This agreement will remain in effect for this procedure and all future brow lamination procedures conducted by Danielle (dhesthetics). I understand that this agreement is binding and that I have read and fully understand all information above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign a physical form in person prior to treatment. *

I affirm

Cannot affirm

Please type your full name below to be used as your official signature for this document * *

Submit

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