Brow Consultation Name * First Name Last Name Date of birth MM DD YYYY Phone * (###) ### #### Email * Do you have any of the following skin conditions? Dermatitis Eczema Psoriasis Extreme Sensitive Skin Do you have any allergies or sensitivities, especially to dyes, tints, or perming solutions Dyes/Tint Perming solutions Are you pregnant, breastfeeding or actively trying to conceieve? If you are, we will not continue as these solutions have not been tested Yes No Are you on medication? Oral or topical? * Includes: Roaccutane, Antibiotics, Prescribed retinols etc. Yes No Consent for photography * I consent to photos/videos taken of my skin/face As long as my identity is hidden I don't consent Disclaimer * I hereby authorise for the trained technician at Dermal Edit (ABN: 46866701107) to perform brow treatments on me. I am over 18 and have given the correct details and history information about me and I accept full responsibility. I have read, understood and will follow all the pre and post care information given to me, and I am responsible for all general care of my brows. I adhere to all of the rescheduling, late and cancellation policies. I understand that all treatments have varying outcomes for every individual. I understand that I may experience a little discomfort, stinging or redness and will let Rebecca know immediately within a 24 hour period. I agree I'm unsure, please explain further Today's date * MM DD YYYY Thank you!
