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Henna Tint Consent Form
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First and last name: *
Date of procedure: *
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Date of birth: *
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Have you had a brow tint or henna before? *
If yes, did you suffer any adverse reaction?
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If yes, list all reactions suffered:
Are you allergic to almond oil? *
Are you pregnant? *
If you suffer from any of the following, your brow treatment may be restricted or refused and you may be asked to contact your doctor for advice: allergies, diabetes, high/low blood pressure, varicose veins, heart condition, haemophilia, epilepsy, radiotherapy. *
I understand that the brow treatment I have requested involves the application of products that may cause an adverse reaction to my hair, skin and/or body. *
Please type your full name below to confirm that you understand and accept these liabilities policies. *
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