Lash & Brow Tint Consent Form
ELKE VON FREUDENBERG SALON NEW YORK, NY 917 475 6845 salon@elkevonfreudenberg.com
Email address *
Full Name: *
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Full Address:
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Home/ Cell Phone: *
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Work Phone:
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Email Address: *
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Have you ever used hair color before? *
Have you ever had an allergic reaction to hair color? *
Do you wear contacts? *
What over-the- counter or prescription skin care products are you currently using? *
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Do you have diabetes, lupus, or any autoimmune diseases? *
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Please list any illnesses or conditions you are being treated by a physician for? *
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Please list any medications you are taking, including over-the-counter herbs, vitamins and supplements: *
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List any allergies you have: *
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Have you ever had your brows or lashes tinted? *
If you had an adverse reaction to a previous brow/lash tint or hair color, please explain: *
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Although every precaution will be made to ensure your safety and well-being before, during and after tinting application, Please be aware of the possible risks below. Please initial: *
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Client Full Name
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Date Signed: *
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Esthetician Signature / Date
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