Treatment Consultation Card Treatment Consultation Card Please tick which treatment you are having: HD Brows Henna Brows Brow Lamination Lash Lift Lash Tint Dermaplaning Hybrid Brows Name * Full address * Phone * Date of birth (DD/MM/YYYY) * GP’s address * Please list any medical conditions or allergies Please list any medication you are taking Please list any past reactions to beauty or aesthetic treatments or products Please list any past reactions to beauty or aesthetic treatments or products Do you use any skin care products containing Retinol, Vitamin A, Glycolic Acid or Alpha Hydroxyl? Are you pregnant? * Yes No Has a patch test been performed? * Yes No Please confirm that the information given above is correct and that you have been given treatment information and advice for the treatment Yes, I confirm Before and after picture consent – we occasionally take pictures of brows, lashes and nails for social media promotion. Do you give us permission to use such photos? * YES, feel free to use them NO, please do not use them Signature (type your name) * Date (DD/MM/YYYY) * Submit If you are human, leave this field blank.
