Brows Form

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Please note, you must fill out this form before our appointment.

First Name

Last Name

Phone

Address

Do you consent to having a Patch Test prior to your treatment? Required

Yes

If no, please click here.

PATIENT CONSENT: This informed consent form has been prepared to help inform you of the potential benefits and risks of brow treatments. You must read this information carefully and discuss fully with your practitioner before proceeding with treatment.

It is also important that you take as much time as you need to consider the treatment carefully, weighing up all your options before reaching an informed decision. It is essential that you are aware of your right to have a second opinion and you are encouraged to ask any questions that come to mind throughout the entirety of the process.

I am aware that results vary between clients and results are dependent on many individual factors. I am aware that there is no guarantee that I will achieve the desired results and that repeat treatments are required to maintain results. I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelash technician addresses me to open my eyes. This is because fumes from the products may irritate my eyes and cause them to water if I open my eyes. I agree to disclose any allergies that I may have to latex, surgical tapes, adhesives or anything applicable.

RISKS AND SIDE EFFECTS: Occasionally clients may develop an allergic reaction to the products used. Your technician will organise a patch test for you at least 48 hours before treatment unless you opt out of this by signing a waiver form. This involves you putting a small amount of the products onto your skin and observing if there is any rash or skin irritation. If there is any reaction the product should not be used on you. A normal patch test is a good indicator that you will not react to the products but it cannot exclude all severe allergic reactions. As with any procedure there are potential risks and complications associated. All of the above brow treatments are safe and low risk procedures, but you must be aware of the following possible risks before proceeding. It would be best if you fully discuss any questions with your practitioner.

Risks and Side effects can include:

Allergic reaction to the products
Skin irritation, redness or swelling.
Minor pain/discomfort
Skin grazes
Mild spots or bumps

I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice.

PHOTOGRAPHS AND VIDEOS: I agree to and authorise the taking of photographs and videos. I understand that these photographs and videos may be used on social media platforms.

All deposits and booking fees are non-refundable unless agreed to with the practitioner.

I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. No new information has become available that affects my decision to have the treatment or my decision to consent. I hereby consent to this procedure, carried out by a practitioner at House Of Luxe.

Do you understand the information you have been provided? Required

Yes

Do you have any medical conditions? Required

Yes

Are you pregnant or breastfeeding? Required

Yes

Do you wear contact lenses? Required

Yes

Do you suffer from oily hair or skin? Required

Yes

Do you have any known allergies or have ever had anaphylaxis? Required

Yes

Do you have any active infection at the intended site of procedure? Required

Yes

Is there any other Medical and/or Social History that we should know? If so, please provide full detail below. Required

Yes

If yes, please add Medical/Social History that we should know.

Have you had this or a similar treatment before? If so, did you experience any problems? Please provide full details below. Required

Yes

If you experienced any problems, please add them here.

Do you have any concerns? If so, please provide full details below. Required

Yes

If you have any concerns, please provide details here.

Your Signature

BROWS FORM

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