BROW LAMINATION CONSENT FORM

Name *

First Name

Last Name

Please select any of the following that apply:

Positive reaction to a patch or sensitivity test (allergy)

Previous reaction experienced to the same or similar service in the past

Skin conditions such as Eczema, Dermatitis, Psoriasis, Lesions or Sores, Open wounds

Contagious skin diseases such as Herpes Simplex, Chicken Pox or Shingles

Skin trauma, cuts, burns and swelling in the immediate area

Infections such as Impetigo or Conjunctivitis

Chemotherapy

Recent operations around eyes, face or scar tissue in immediate areas

Hypersensitive skin/eyes

Alopecia

Trichotillomania

Any disease/disorder that causes shaking, twitching or erratic movements

Steroid or cortizone creams. Please provide medical clearance from dermatologist or doctor

Brow growth serums

Spray tans or self tanning lotions

Very dry skin

Pregnant or lactating

Contraceptive pill or HTR

Post Chemotherapy. Please provide medical clearance from your doctor

Recent microblading or tattooing service

Botox and dermal fillers

Anti-acne medications such as Roaccuataine, doxycycline and epiduogel etc.

Anti-aging creams such as Vitamin A, Retinols, AHA's and BHA's

Brow henna application

Sunburn