Consultation and Consent Form For: HD Brows | Henna Brows | Brow Lamination | Hybrid Tint | Waxing | Threading | Lash Lifts | Tweezing This form is required to be completed prior to any treatment and kept on file as part of your insurance and health & safety compliance.Please read terms and conditions, and treatment advice here. Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Emergency Contact Name * Emergency Contact Phone Number * What treatment have you booked? * Lash Lift HD Brows Hybrid Brows Brow Lamination Henna Brows Package Anna K is obligated to perform treatment in strict compliance with all hygiene and health protection measures. In order to perform the eyebrow drawing treatment in a safe manner, please answer the following health question truthfully. Medical History - Select all that apply * Skin conditions (eczema, psoriasis, dermatitis) Allergies (including to tint, henna, adhesives, latex) Eye conditions (conjunctivitis, blepharitis, styes) Epilepsy or seizures Pregnancy or breastfeeding Diabetes Blood-borne diseases (e.g., hepatitis, HIV) Recent use of Retin-A, Accutane, or other skin-thinning products Immune disorders or slow healing Botox or facial fillers in the past 4 weeks Chemical peels or skin treatments in the last 4 weeks Other None Please provide any further relevant information * A patch test is required at least 48 hours prior to any tinting, henna, or lifting treatments. I confirm that I have received a patch test and had no adverse reaction. Yes No (If no, treatment will not proceed) Date of Patch Test and by whom? Confirmations * Please select all I confirm that I have read and understood the explanation, warranty, top up , treatment notes and further information above. I received a clear and understandable response to all my questions. The treatment procedure and post-treatment care was explained to me in detail and I agree with it. I do not have any further questions and complaints If I have further questions or concerns, I will contact Anna K Beauty Signature (by typing your name and submitting this constitutes as your signature) * Thank you!
