Brow Thread/Wax/Tint Consent Form

First name

Last name

Phone

Birthday

Month

Day

Year

Address

Emergency Contact Name

Emergency Contact Phone Number

How did you hear about us?

Have you had your brows waxed before?

Yes

Have you had your brows threaded before?

Yes

Have you had your brows tinted?

Yes

Currently or previously on Retin A or Accutane?

Yes

Currently using any AHA, BHA or Glycolic Acid?

Yes

Is your skin easily bruised, scarred or prone to irritation?

Yes

Any allergies to cosmetic, topical creams, skincare products, or adhesives?

Yes

Have you had any facial injections or procedures done in the last 30 days?

Liability Release

I authorize my Licensed and Certified Artist to perform the eyebrow service wax/thread/tint.

I understand there are risks associated with wax/thread/tint. I further understand that as part of the procedure eye irritation, itching, discomfort, and in very rare cases eye infection or blindness can occur. I agree that if I experience any of these medical conditions with my eyebrows that I will contact my Licensed and Certified Artist.

I understand and agree to the aftercare instructions provided for my eyebrows.

This agreement will remain in effect for this procedure and all future procedures conducted by the Licensed and Certified Artist. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I am over 18 of age and consent to the agreement and treatment.

I release my Licensed and Certified Artist from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the artist has been trained to use.

By checking the box, I verify that I have read and understand the above statements and agree to them.

Photo Consent & Release

I am allowing Multifaceted Artistry or delegated photographer to take photos of my treatment and/or treated areas to be used to the purpose of monitoring my progress. In addition:

I give permission for my photos and/or videos to be used for educatonal, advertising, social media and other marketing purposes for Multifaceted Artistry, LLC

At my request, my identity will remain anonymous

Credit Card Authorization

I authorize Multifaceted Artistry, LLC to save my card on file. I authorize Multifaceted Artistry, LLC to charge my card only for agreed upon purchases, no show or late cancelations. I understand that my information will be saved for future transactions on my account and my banking information is not visible to anyone including my service provider and owner of the company.

By checking the box, I verify that I have read and understand the above statements and agree to them.

Brow Thread/Wax/Tint Consent Form

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