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Brow Lamination & Tint Information and Waiver Form

An intake and waiver form that collects a client's skin and health history before a brow lamination or tint service, along with their liability acknowledgment.

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Page 1

Name

Nombre

Apellido

Phone Number

Service

Brow Lamination Brow Tint

Have you had reaction to previous brow lamination or lash lift?

Yes No

Do you have a very sensitive skin?

Yes No

DId you have microblading or any semi-permanent brow procedure in the last 2 months?

Yes No

Are you taking any skin medication (i.e. accutane)?

Yes No

Are you currently taking any skin routine such as applying AHA, BHA, Retinol (ex. anti-aging skin prosecutors)?

Yes No

Are you pregnant or currently breastfeeding?

Yes No

Do you have a wound or scar tissue or pimple in the area to be treated?

Yes No

Page 2

Waiver and Consent Statement

Name

Nombre

Apellido

Phone Number

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