Client Information (Please complete the following details)Client NameEmail AddressPhone NumberDate of BirthHealth Questionnaire Please provide details where applicable:Existing or Recent IllnessHospitalization / SurgeryMedication IntoleranceAesthetic Procedures in the Treatment Area:Medical History Please check all that apply and inform your service provider:Pregnancy or currently nursingUnder 18 years of age (unless parental/guardian consent is provided)Active acne, open wounds, or infections in the eyebrow areaHistory of keloid or hypertrophic scarringBlood disorders or use of anticoagulant therapyCurrent use of Accutane® or use within the past 6 monthsAutoimmune diseases (e.g., lupus, scleroderma)Skin conditions affecting the eyebrow area (e.g., eczema, psoriasis)Diabetes (uncontrolled)Active cold sores/herpes simplex virus near the treatment areaRecent chemical peels, microdermabrasion, or laser treatmentsAllergies to dyes, pigments, anesthetics, or topical productsAcknowledgment and Consent: I confirm that I have provided accurate and complete information regarding my medical history and current health status. I understand that eyebrow treatments (e.g., waxing, tinting, shaping, lamination, microblading, or threading) involve manipulation of delicate skin and hair in the eyebrow area. I have been informed of the potential risks and side effects, which may include but are not limited to redness, swelling, irritation, tenderness, allergic reactions, skin sensitivity, temporary pigment changes, or minor scabbing (for semi-permanent procedures). I acknowledge that individual outcomes vary depending on skin type, previous treatments, and adherence to post-treatment care. I understand that certain medical conditions and medications may increase the risk of side effects and that I should follow all aftercare instructions carefully to support healing and maintain results. I release Unique Styles Hair and Esthetics, its staff, and affiliates from any liability associated with this procedure, understanding that all reasonable precautions will be taken for my safety. I voluntarily consent to proceed with the eyebrow treatment at Unique Styles Hair and Esthetics. Post-Treatment Care: Avoid touching, rubbing, or applying makeup on the treated area for at least 24 hours. Protect the area from direct sun exposure and avoid swimming, saunas, or intense sweating for 48 hours. Follow any specific aftercare instructions provided by your service provider. Contact Unique Styles Hair and Esthetics if you experience excessive redness, swelling, discomfort, or signs of infection. Client NameClient SignatureDateSend Message
