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FFBC

Brow/Face Consent Form

Client Information

Birthday
Month
Day
Year
Which of the following services have you had done in the PAST?

Services to be Provided

Select as many as you're comfortable with:

Please note, you may be a better candidate for one method over another depending on any contraindications. We will discuss those options in person. You will be asked to fill out the form again if we decide to perform a service that you have not consented to on this form.

Health History

Do you have any medical conditions?
Yes
No

Such as: rosacea, eczema, psoriasis, cystic acne, diabetes, bleeding disorders, thyroid disorders, autoimmune diseases, vein issues, heart problems, etc...

Are you currently pregnant or breastfeeding?
Yes
No

Hormonal changes can affect skin sensitivity.

Are you taking any medications (oral or topical)?
Yes
No

Especially antibiotics, blood thinners, or steroids.

Do you use Retin-A, Renova, or Retinol/Vitamin A derivative products?
Yes
No
Have you used any alpha-hydroxy acid or glycolic acid products in the last 48 hours?
Yes
No
Unsure
Are you currently taking ANY acne medications or taken them in the past?
Yes
No
Have you had a skin cancer diagnosis at any point?
Yes
No
Do you have any topical allergies that you're aware of?
Yes
No

Especially to products, latex, or metals

Please notify your esthetician of any allergies prior to your service.

Have you had recent surgeries or cosmetic procedures (chemical peels, fillers, Botox, laser treatments)?
Yes
No

Especially within the past 2–4 weeks.

Lifestyle & Skin

Do you have any existing skin conditions or concerns?
Yes
No
Check all that apply:
Have you experienced breakouts, rashes, or irritation from facial products or hair removal in the past?
Yes
No
Sometimes
Is skincare important to you?
Absolutely
Not really
Sometimes
Do you wear makeup on a daily/regular basis?
Yes
No
Sometimes
Do you spend a lot of time in the sun or use tanning beds?
Yes
No
Sometimes
Do you wear SPF daily?
Yes
No
Sometimes
Do you drink enough water daily?
Yes
No
Sometimes
Do you smoke or consume alcohol frequently?
Yes
No
Sometimes

These can affect skin healing and appearance.

Are you planning any special events or travel soon?
Yes
No

Post-treatment care is important; skin may be red or sensitive for a day or two.

Procedure Understanding and Consent

I, the undersigned, request and consent to the application of waxing, sugaring, threading, and tinting procedures to my eyebrows and/or facial areas by the trained technicians of Fearless Femme Beauty Company.​

Video and Photo Consent

Please choose one:
I consent to the use of photographs or videos taken during my service for promotional purposes, understanding that my identity will remain confidential unless otherwise agreed upon.
I do not consent to the use of photographs or videos for promotional purposes.

Client Acknowledgment

  • I have provided accurate and complete information regarding my health, allergies, medications, and skin conditions. I understand that withholding information may result in adverse reactions.​

  • I agree to inform my esthetician of any changes to my health status or skin conditions prior to each service.

  • I understand that Fearless Femme Beauty Company reserves the right to refuse service to anyone exhibiting contraindications or not adhering to health and safety protocols.

Liability Waiver

I, on behalf of myself and my heirs, release and hold harmless Fearless Femme Beauty Company, its employees, and contractors from any and all liability, claims, actions, or demands arising from or related to the services provided, including but not limited to allergic reactions, skin irritation, or other adverse effects.

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Date
Month
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- FFBC -

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301.264.6069

1197 N. East Street Frederick, MD 21701

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