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Brows Intake Form

Lamination | Waxing | Henna

Please read each statement, initial in each box and sign this document to accept your acknowledgement and agreement of the following:

I affirm that I am 18 years of age or older, and competent to sign this release on my own behalf. I have read and fully understand this agreement and all information detailed above. I understand the service and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the aesthetician, Kate Aglaia Aesthetics, responsible for any of my conditions that weren’t disclosed at the time of the skin care service, which may be affected by the treatment performed. I understand that this agreement will remain in effect for this procedure and all future procedures conducted by my technician. Although it is impossible to list every potential risk and complication, I have been informed of possible risks and complications. I have also, to the best of my knowledge, given an accurate account of my medical history, including known allergies or prescription drugs or products I am currently ingesting or using topically. The nature and purpose of the products to be used in this service has been explained to me, along with the risks and hazards involved. 

✦ Waxing for hair removal, particularly on the face carries risks. These risks may include redness, bruising and lifting of the skin. These conditions may be exacerbated by the use of certain pharmaceuticals and cosmetics, particularly those for anti- aging and anti-acne treatments. Examples of these are retinoid, Retin-A, Renova, Accutane, and AHA’s like glycolic acid. Face waxing should be avoided when using these products.

✦ Certain prescription medications may aggravate the skin when waxed, particularly those causing photo-sensitivity (sensitive to sunlight). Examples of these are many antibiotics, such as tetracycline, and blood thinners such as Warfarin, which may cause an individual to bruise easily.

✦ Clients who are receiving aesthetic and dermatological peeling treatments may also experience redness and skin lifting from waxing and therefore should avoid waxing while undergoing such treatments.

✦ The use of tanning booths can also contraindicate waxing. Waxing should not be done 24 hours before or after tanning. It should also not be done on an area that still shows an erythema (redness) from tanning.

✦ Because the fields of pharmacology and dermatology are continually changing and expanding, there may be products and drugs that cause negative reactions to waxing that have yet to be documented.

Have you used any of the following in the last 48 hours?:
Check all the following that apply:
Do you participate in vigorous aerobic activity or sports?:
Have you received Botox, Restylane, or Collagen injections in the last 6 months?:
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