Waxing & Consent Form

Please fill out this form.

First Name

Last Name

My body temperature is lower than 98.6°F/ 37.5°C

Do you use Retin-A, Renova, or Retinol/vitamin A derivative products?

Yes

Are you currently taking Accutane or have you taken it in the past?

Yes

Do you take any medication?

Yes

If yes, which ones?

Please notify me of any allergies prior to your service/procedure.

I understand there are risks associated with an eyebrow tint. I further understand that as part of the procedure, eye/skin irritation, eye/skin pain, eye/skin itching, discomfort, and in rare cases infection or blurriness could occur. I agree that if I experience any of these medical conditions with my eyes, lashes, or skin that I will contact my technician and consult a physician at my own expense.

I understand that even though my technician waxes and tints using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and solutions used may irritate my eyes and/or skin and may require a physician’s follow-up care.

I acknowledge that I have read and understand the above statements and agree to them.

Thanks for submitting!