BROW LAMINATION DISCLOSURE & CONSENT AGREEMENT 

Brow Lamination is a topical eyebrow styling treatment that achieves lifted and fuller looking brows with a sleek finish. It uses a three step process that includes perming (the bond of the hair is loosened to move and be reconstructed), fixing (the hair is set to maintain easier) and nourishing your natural eyebrow hairs. Eyebrow mapping, shaping, tweezing, and tint are optional services. Brow Lamination lasts approximately 4-8 weeks; Brow tint lasts approximately 2-5 weeks; this will differ based on the type of hair and skin type. (+Patch test required for sensitive skin types)

CONTRAINDICATIONS:

*Epilepsy *Chemotherapy *Drug or Dietary Supplement that may induce bleeding or reduce clotting *Sick (cold, flu, etc) *Pregnant or Nursing *Major Heart Problems *Psoriasis, Eczema, Rash, Dermatitis, Lesions, Sores, Open Wound, Swelling, Scar Tissue or Sunburn on or around treated area *Pink Eye *Alopecia *Trichotillomania *Recent Permanent Makeup (under 6 weeks) *Previously reacted to same or similar service *Hypersensitive Skin/Eyes *Very Dry Skin *Contagious Skin Diseases (such as Herpes Simplex, Chicken Pox, or Shingles) *Spray Tans or Self-Tanning Lotions *Brow Growth Serums *Curly Brows 

AFTERCARE:

Keep brow hairs in place + dry/clean for 24-48 hrs  

Avoid touching the brow area at the risk of transferring oils

Avoid exposure to high temperatures

No Retin A, AHA or exfoliate on the brow area for 72 hrs 

After 24-48 hrs apply oil/balm/cream and brush daily 

NOTE: If any irritation or swelling occurs, apply a cold compress to soothe and seek medical advice. Be sure to let the technician know of any adverse reactions.

  • Wait 6-10 weeks in between lamination appointments

If I have any condition that might interfere with Brow Lamination or Tint, I will advise my technician. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.

I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid), skin disease (e.g. eczema or psoriasis), skin infection, lesion (e.g. mole) or sunburn in the forehead area that might interfere with the Brow Lamination Process. If I have any type of infection or rash anywhere on my body, I will advise my technician .

I acknowledge no warranty has been made to me as a result of this semi permanent procedure, and that the final result cannot be guaranteed. Brow Lamination is considered semi-permanent, hair will relax back to its natural state in approximately 4-8 weeks. Natural By Nature and/or the technician performing the Brow Lamination will not be held liable for any damage caused to me or my eyebrows for any reason, including allergic reaction, skin sensitivity, any damage caused to previous procedures such as prior henna/tint on the brow, or failure to follow the Brow Lamination aftercare instructions.

I acknowledge that as part of the procedure, eyebrow irritation, eyebrow pain, eyebrow itching, discomfort, and in rare cases eyebrow infection. I understand that signs of infection include fever, drainage, swelling or redness. I have been instructed to contact a medical provider if signs of infection or complications occur. If I do not have a local provider I can call Riverstone Health at 406· 256· 2770 for assistance.

I acknowledge I am over the age of eighteen and that I have truthfully represented to my technician that the obtaining of Brow Lamination is by my choice alone. 

I hereby give Shelby Yarbrough and/or Natural By Nature permission to copyright or publish and/or use photographs of me to be shown on social media (Instagram/Facebook/etc.) or advertising, or any lawful purpose whatsoever. I waive any right I may have to inspect and/or approve the finished product or use of to which it may be applied. 

DO YOU HAVE OR HAVE YOU PREVIOUSLY HAD ANY OF THE FOLLOWING:

Please circle 'Yes’ or ‘No’

YES NO Brow/Lash Tinting/Lifting Date: ___________

YES NO Botox, Last Treatment Date: _____________

YES NO Diabetes, Type: _____________

YES NO Hepatitis: A B C D

YES NO Forehead/Brow Lift

YES NO Easy Bleeding

YES NO Alcoholism

YES NO Recreational Drugs, Please List: _____________

YES NO Smoker

YES NO Heart Condition

YES NO Chemical Peel, Last Treatment: _____________

YES NO Facial Laser Treatment, Last Treatment: _____________

YES NO Pregnant or Breastfeeding

YES NO Brow or Lash Serums

YES NO Autoimmune Disorder

YES NO Cancer, Year: _____________

YES NO Accutane or Acne Medication

YES NO Chemotherapy or Radiation

YES NO Currently Undergoing Hormone Replacement Therapy

YES NO Hypothyroidism 

YES NO History of Keloids or Scarring Easily

YES NO Taking Blood Thinners: Aspirin, Ibuprofen, Niacin, Vitamin E, Alcohol, Taking Energy/Workout Supplements

YES NO Microblading/Tattoo Service Date: ___________

YES NO Brow Henna Date: ____________

YES NO Using any skin care products containing: Retin-A. Glycolic or Alpha-hydroxy

YES NO Have you ever had fever blisters/cold sores?

Any Additional information you feel is important to your treatment(s)?

Please Read and Initial Each Line:

            Aftercare instructions have been explained and a written copy has been given to me, which I will follow to the best of my ability. I realize and accept the consequences of failure to adhere to these instructions may cause the eyebrows to not stay permed as long as told. I will call or email if I have questions.

             I understand that I must keep laminated eyebrows clean, dry, and kept in place for at least 24 hours.

             I understand there are risks associated with having an eyebrow lamination/and eyebrow tint. I further understand that as part of the procedure, eyebrow irritation, eyebrow pain, eyebrow itching, discomfort, and in rare cases eyebrow infection. I agree that if I experience any of these medical conditions with my eyebrows, I will contact my technician and consult a doctor at my own expense.

             I understand that chemical products are used to treat the hairs. If I am susceptible to an allergic reaction I will need a patch test prior and reschedule before proceeding with Brow Lamination. It is my responsibility to advise the technician of any concerns I may have prior to the Brow Lamination procedure.

​          I understand some redness or mild sensitivity can occur but does not typically last more than a few hours. Despite the use of the most high-quality ingredients, an allergic reaction is possible.

            I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas for 72 hours. They will cause premature exfoliation.

              I understand that there are many factors that may affect the life of the eyebrow lamination/tint such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures.

              I​ understand there are no guarantees for the length of time the eyebrows will stay permed and/or tinted. 

              I agree to have a brow lamination lift and/or eyebrow tint applied to my natural eyebrows and/or retouched. 

I give permission to Natural By Nature to perform a Brow Lamination and/or Tint. I have accurately answered the questions above, and understand the risks associated with receiving the treatment. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks and will not hold Natural By Nature or the technician liable.