Eye treatment consent form
Consent Form for Brow and Lash Treatments
No children or babies are allowed during any service.
This is a home-based nail salon, with pets at present. Please consider this when booking with me. I am only able to accommodate one person at a time. Please make sure you arrive without company.
If you are booked in for tint, make sure you don't apply fake tan for 3 days before and 3 days after your treatment, as the tint can react to tan, turning it into a green shade.
Patch Test Requirement:
All brow and lash treatments (including brow waxing, tinting, and eyelash tinting) require a patch test at least 48 hours prior to your appointment. Patch test results are valid for six months, after which the test must be repeated.
🔹 General Contraindications (apply to all treatments):
- Skin infections or disorders (e.g. impetigo, herpes simplex/cold sores, warts, fungal infections)
- Open wounds, cuts, or abrasions in the treatment area
- Bruising or swelling
- Recent scar tissue (less than 6 months old)
- Sunburn
- Allergic reactions or history of sensitivity to treatment products
- Contagious eye conditions (e.g. conjunctivitis, styes, blepharitis)
- Use of topical medications like Retin-A, Accutane, or steroid creams on the face
- Recent chemical peels, microdermabrasion, or other intensive facial treatments
- Cancer treatments (e.g. chemotherapy/radiation—consult doctor’s note)
- Skin thinning medications (e.g. blood thinners or topical retinoids)
🌿 Contraindications for Brow & Eye Treatments (tinting, lifting, extensions):
- Eye infections or disorders (e.g. conjunctivitis, styes, blepharitis)
- Watery or irritated eyes
- Recent eye surgery or laser eye correction (within 6 months unless approved by a doctor)
- Glaucoma
- Claustrophobia (especially for lash extensions or lash lift with closed eyes)
- Allergy to adhesive, tints, or perming solutions
- Contact lenses (should be removed for treatment)
- Pregnancy (due to hormonal changes increasing risk of reaction—patch test always required)
- Eczema or dermatitis around the eye area
🧼 Contraindications for Facial Waxing:
- Active acne or cystic breakouts in the area
- Recent exfoliation or chemical peel treatments
- Use of retinoids, Accutane, or AHA/BHA products
- Sunburned or sensitive skin
- Moles or skin tags (can be avoided but must be noted)
- Varicose veins in waxing areas (if applicable to face/neck)
- Poor hygiene or unclean skin (can increase infection risk)
Allergic Reaction Information:
If you experience redness, swelling, itchiness, or burning following the patch test, this indicates a potential allergic reaction, and the treatment cannot proceed.
Please note that a patch test does not guarantee immunity from allergic reactions during or after the treatment. If an allergic reaction occurs:
Mild reactions: Over-the-counter antihistamines may help reduce symptoms.
Severe reactions: Medical attention may be required.
Modern Manicure Co. is not responsible for any medical expenses arising from allergic reactions.
Appointment Preparation:
For the best results, please arrive at your appointment without makeup, if possible.
By proceeding with the appointment, you acknowledge and accept these terms.
This form needs to be filled out before each appointment for insurance purposes.
You will receive automatic communication via email and text message related to your appointment.