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Brow Services Consent Form

Brow Lamination ~ Tinting ~ Threading ~ Microblading ~ Ombre Consent Form

No client may be treated without completing a consent form

    Please Check Each Box

    I am requesting and consent to have Madison Laser Spa perform a brow lamination/tinting/threading/microblading on my eyebrows.

    I understand the risks associated with the brow lamination, tinting, threading, waxing, tweezing, microblading, ombre. I understand that with this procedure,I may experience skin or eye irritation, eye pain, eye itching.

    I understand Brow Lamination, tinting, threading, microblading correction is a process of reconstructing the brows hairs to keep them in a desired shape, but it is my own responsibility to brush them daily to achieve the desired look daily.

    I understand that the brows after Brow Lamination/tinting/microblading must stay dry for 48 hours

    I understand experiencing some redness of the skin or mild sensitivity is normal but does not typically. Despite application of the most advanced and top ingredients, an allergic reaction is possible.

    It is my responsibility to note and advise my esthetician of any concerns I may have before my Brow procedure

    The minimum or maximum duration of the lamination/tint from the procedure cannot be determined with certainty. Loss of hair or skin reactions may occur if I have weak brows or my hair / skin type do not tolerate the solution/products used. The esthetician providing the service and Madison Laser Spa will not be held liable for any damages caused to me or my eyebrows.

    I acknowledge and accept the following risks by signing my name at the bottom of this consent: During the treatment, despite all precautionary measures, injury is possible. I will not hold the technician or business performing this service on me responsible in any way for any damages or issues that may arise as a result of having the Brow Lamination procedure performed on me.

    Medical History
    Please check any/and all that apply to you:*

    Required For Treatment: I consent to photographs being taken BEFORE, DURING, and AFTER my procedure. I agree to these being stored with my case file and will be used with the below written consent for promotional and social media purposes.

    Photo for Personal Records X Photo Consent for Madison Laser Spa Social Media X Print

    By participating as a client, I permit, authorize, and license the technician(s) Madison Laser Spa and their employees +1099 staff ("Authorized Persons"), to display, publicly perform, use for social media exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, to use my image, likeness, and appearance, and all materials created by or on behalf of my participation that incorporates any of the foregoing ("Materials") on a perpetual basis in any medium or format now existing for publicity, advertising, and marketing, sales purposes, and for any purpose they deem reasonably appropriate, without further consent from or royalty, payment, or other compensation to me. I agree that all right, title and interest in and to all such Materials is the exclusive property of the Authorized Persons/Business. Accordingly, I release the Authorized Persons/Business from all liability or responsibility that may arise from the acts that I have authorized or consented to in this Section. I am signing my name below stating that I understand everything pertaining to use of likeness and release.

    I certify I read and fully understand all information listed above. I represent that I am over 18 and or if under the age of 18, I have a parent or guardian signature below and that he/she consents to this procedure under these terms. I have completed this form to the best of my ability and knowledge and agree to inquire about questions I may have before Madison Laser Spa LLC begins performing this procedure. I have been informed of and understand contradictions to the requested treatments and agree that I don’t have any conditions that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience during the requested treatment to allow them to adjust accordingly. I agree to waive all liabilities toward the technician and Madison Laser Spa LLC for any injury or damages incurred due to any misrepresentation of my health history. I agree that it is my responsibility to advise the technician of any concerns and medical conditions / medications I have, before participating as a client/customer and having any service performed on me, even though I may have written it down in this Consent. I recognize and acknowledge that there are certain risks of personal injury or property damage related to my participation as a client, and I voluntarily agree to fully assume all of these risks, regardless of severity, that I may sustain as a result of participating in any and all activities connected with or associated with the application by the technician of ANY BROW service performed at Madison Laser Spa.

    By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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