Brow Lamination & Tinting Consent Form

CLIENT CONSENT AND LIABILITY RELEASE

SECTION 1: ACKNOWLEDGMENTS AND AGREEMENTS 

 

Please sign at the bottom of these statements to accept your acknowledgement and agreement to the following:


That I have been given a copy of this Client Consent and Liability Release (the "Release") prior to the Brow Services being performed on me. 

That it is my responsibility to advise the esthetician of any concerns I may have before participating as a client/customer and having this service performed on me, even though I may have written it down in this Release. 

That I have read and accepted the risks set forth in Section 2. 

I have been given the opportunity to ask questions, either by written or verbal communication, prior to signing this Release. 

As a result, I have sufficient information to give this informed consent. 

That I must complete the Health Questionnaire in Section 3 before I can have this service performed on me. 

I understand my participation as a client may be refused depending on my responses, including but not limited to, if I am pregnant, nursing or if I have any allergies or contraindications. 

That no warranty or guarantee has been made to me as a result of the Brow Services, and that the final result cannot be guaranteed as each skin type is unique.

SECTION 2: RISKS 

 

I acknowledge and accept the following risks by signing my name at the bottom of these statements.


1. During the treatment, despite all precautionary measures, injury is possible. I will not hold the esthetician or business performing this service on me responsible in any way for any damages or issues that may arise as a result of having Brow Services performed on me. 

2. Despite application of the most advanced and top ingredients, an allergic reaction is possible.

3. The minimum or maximum duration of the procedure cannot be determined with certainty. 

4. The esthetician and the business performing the service on me will not liable for any damages caused to me or my brows in any way caused by any reason, including allergic reaction, reaction to previous procedures such as previous henna/tint on the brow hair, skin sensitivity, and my failure to follow the Aftercare Instructions. 

SECTION 3: HEALTH QUESTIONNAIRE

 

To perform the procedure in a safe manner, please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for this procedure.

Are you pregnant or nursing?
Recent eye surgery?
Recent brow tattoo? (Must be fully healed)
Medical conditions? (i.e. cancer, hemophilia)
Skin conditions? (i.e. Psoriasis, Eczema, etc.)
Recent botox/filler? (Must wait 2 weeks)
Are you taking medications? (i.e. Accutane, Blood Thinners, etc.)
Have you ever been allergic to, or have had an allergic reaction to perm solution or hair dye?

If you answered yes to any of the above statements please state what they may be and how severe it is presently.

SECTION 4: USE OF LIKENESS AND RELEASE

 

By participating as a client, I permit, authorize, and license the esthetician(s) and the Business and their employees and staff and all of them ("Authorized Persons"), to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use, and permit others to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for publicity, advertising, and marketing purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me.

 

I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons/Business. I understand that the Authorized Persons/Business may keep or use the Materials now and in the future. I understand that although the Authorized Persons will endeavor to use my image, likeness, and appearance in accordance with standards of good judgment, they cannot warrant or guarantee that any further dissemination of my image, likeness, and appearance will be subject to their supervision or control. Accordingly, I release the Authorized Persons/Business from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section.   


I am typing my name below stating that I understand everything pertaining to USE OF LIKENESS AND RELEASE.

I HAVE READ THE INFORMATION IN THIS WAIVER THOROUGHLY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE THE CAPACITY TO PROVIDE INFORMED CONSENT AND I AM SIGNING THIS WAIVER AND RELEASE FREELY AND VOLUNTARILY.

Thanks for submitting!