LASH LIFT & BROW TINT CLIENT CONSULTATION & CONSENT FORM

Client Details

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Medical & Allergy History

Please Tick & Provide details Where Applicable

Sensitive skin

Allergies (Please Specify Below)

Eye infections / conjunctivitis

Recent eye surgery

Skin conditions (eczema, dermatitis, psoriasis)

Pregnant or breastfeeding

Currently using medication affecting skin (e.g., Roaccutane, Retinol)

Other

Additional Details

Patch Test Declaration

I confirm I have had a patch test at least 24–48 hours prior to treatment

I confirm I have not experienced any adverse reaction

I understand that failure to disclose allergies may increase risk

Date of Patch Test

Treatment Details

Treatment

Lash Lift

Brow Tint

Both

Desired outcome discussed

Technician Name:

Date of Treatment

Contraindications Acknowledgment

I confirm that I have disclosed all relevant medical conditions and understand that treatment may be refused if deemed unsafe.

Informed Consent

I acknowledge that:

I confirm that I have disclosed all relevant medical conditions and understand that treatment may be refused if deemed unsafe.

There is a risk of irritation, allergic reaction, redness, swelling, or damage to natural lashes/brows

Results may vary depending on hair type, skin condition, and aftercare.

Liability Waiver

I understand that all reasonable care will be taken during my treatment.

I agree that the business will not be held liable for adverse reactions where:

Avoiding water/steam for 24–48 hours
Avoiding rubbing or touching the treated area
Avoiding oil-based products around eyes

Nothing in this agreement excludes liability for death or personal injury caused by negligence, in accordance with UK law.

Aftercare Responsibility

I agree to follow all aftercare instructions provided, including:

Avoiding water/steam for 24–48 hours
Avoiding rubbing or touching the treated area
Avoiding oil-based products around eyes

I understand that failure to follow aftercare may affect results and increase risk.

Signature

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By signing above, you confirm that all information provided in this form is true, accurate, and complete to the best of your knowledge. You acknowledge that you have read, understood, and agree to all terms, conditions, and information outlined within this form, and accept full responsibility for the details you have supplied.