brows

Client Intake Form

facts to know pre-Eyebrow & Eyelash tinting

The product I use is Pialan Hair Dye, a Dr. Temt product. All Dr. Temt products are handmade in Vienna, Austria, from the finest raw materials, using Old World manufacturing processes.

Eyelash dye is an oxidation tint, which needs to be mixed with hydrogen peroxide in order to impart a permanent color. This water resistant and smudge-proof tint is for lashes and eyebrows, and can last up to 7-8 weeks, depending on the hair type.

INGREDIENTS: WATER, CETEARYL ALCHOHOL, PED-20 STEARATE, P-PHENYLENEDIAMINE.
PLEASE NOTE: P-Phenylendiamine (PPD) may cause skin irritation on certain individuals. PPD is an organic compoudn. The us of PPD as a hair dye is popular because it is a permanent dye that gives a natural look. PPF is a colorless substance that requires ocygen for it to become pigmented. It is thies intermediate, partially oxidized state that may cause allergy in sensitive individuals.


previous history Questionnaire & Waiver

Name & Contact Info
Name *
Name
Previous History
Do you have any of the following conditions?
Please check all that apply.
Are you taking any of the following medications?
Please check all that apply.
If yes, please specify.
If yes, please specify.
Liability Waiver
I know and accept the risks involved with any conditions I have that may cause injury as a result of Waxing, Eyebrow Tinting, and/or Eyelash Tinting *
Please check the box below.
By checking the box below, I indicate that I understand all of the aformentioned precautions, risks, and aftercare involved in Waxing, Eyebrow, and Eyelash Tinting. I release Jimena Garcia from all liability and waive all claims relating to my services from Jimena Brows. I agree to tell Jimena Garcia if any of the answers to this Questionanaire change before any future visits. *
Please check the box below.
Date
Date