Name *

First Name

Last Name

I will follow the before and after care recommendations from my esthetician and understand that failure to do so may result in undesired results. *

Agree

I understand that on rare occasion, a skin reaction can occur. *

Agree

I understand that it is best to keep my eyes closed during the procedure to help avoid an accident. *

Agree

I am not pregnant or breastfeeding. *

Agree

I have not used any Retin-A, AHA (alpha-hydroxy acids), microdermabrasion or any other type of chemical peel/ intense exfoliant 3 days prior to my appointment. Also, I am not on Accutane. *

Agree

I understand the risks associated with having my eyebrows laminated. *

Agree

I release my esthetician from liability associated with this appointment and future appointments of the same service. *

Agree

Date

MM

DD

YYYY