Live example
- nothing you submit is saved.
Back to the template
Brow Treatment Consent
Please complete before your brow appointment.
Full name
*
(required)
Email address
*
(required)
Phone number
Date of birth
*
(required)
Which treatment?
*
(required)
Select…
Brow tint
Brow lamination
Lamination and tint
Henna brows
Threading or waxing
Microblading consultation
Safety checks
Have you had a patch test with us?
*
(required)
Select…
Yes, within the last 6 months
Yes, but over 6 months ago
No - I understand one is needed first
When was your patch test?
Do any of these apply?
*
(required)
Eye infection or conjunctivitis
Recent eye surgery
Alopecia or brow hair loss
Psoriasis or eczema near the brows
Chemotherapy in the last 6 months
Known dye allergy
None of these
Brow treatments in the last 6 weeks?
Are you pregnant or breastfeeding?
Select…
No
Yes
Prefer not to say
Confirmations
I understand that reactions, irritation and hair loss are possible
*
(required)
I will keep the area dry for 24 hours and follow the aftercare given
*
(required)
The information above is accurate
*
(required)
Leave this field empty
Send
Powered by
⋀⋁⋀
42