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SIGNATURE REFINED BROWS CLIENT CONSULTATION FORM

-personal and confidential-


SIGNATURE REFINED BROW CONSENT AGREEMENT

The Signature Refined Brow includes a brow lamination, brow shaping, tint and a wax. 

I understand and acknowledge that I am of the full age of 18 years or older. If below 18 years of age a parent or guardian must also sign this form. I confirm that I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to agree to the terms of this agreement or safely commence the procedures herein. This agreement will remain in effect for this procedure and all future procedures conducted by my technician conducting business at Refined by Riley I understand that this agreement is binding and that I have read and fully understand all information above.

WAXING AND BROW LAMINATION CONTRAINDICATIONS 

A contraindication is a condition that labels the client as unfit for this treatment. Please consult with me before the procedure if you can have any of the following:

PLEASE READ AND SIGN, CONSENTING THAT NONE OF THESE APPLY TO YOU.

WAXING IS NOT RECOMMENDED FOR CLIENTS WHO ARE OR HAVE ANY OF THE FOLLOWING:

  1.  Recent sunburn or tanning.
  2. Recent use of certain medications, such as Accutane.
  3. Skin conditions like psoriasis, eczema, or dermatitis.
  4. Open wounds, cuts, or abrasions on the skin.
  5. Recent cosmetic or reconstructive surgery in the waxing area 
  6. Allergies to wax or its components.
  7. Use of certain skincare products containing retinoids or alpha hydroxy acids.
  8. Pregnancy, especially in sensitive areas.
  9. Certain medical conditions like diabetes or circulation problems.
  10. Immunocompromised individuals or those with a weekend immune system. 
  11. History of adverse reactions to waxing.
  12. Certain blood thinners. 

BROW LAMINATION & TINT IS NOT RECOMMENDED FOR CLIENTS WHO ARE OR HAVE ANY OF THE FOLLOWING.

  • Psoriasis
  • Eczema
  • Alopecia
  • Sunburn
  • Ultra sensitive skin
  • Wounds or scar tissue in the treatment area
  • Infection
  • Pimple in the treatment area
  • Pregnancy (without doctor approval)

BROW LAMINATION & TINT AFTERCARE

  1. Avoid Getting Brows Wet: Refrain from getting the brows wet for the first24-48 hours after the lamination.
  2.  Avoid Touching or Rubbing Brows.
  3.  Avoid Oil-Based Products: Avoid using oil-based skincare products or makeup removers on the brow area, as they can weaken the lamination effect.
  4.  Avoid Heat and Steam: Steer clear of activities that involve heat or steam, such as hot showers, sAunas, or steam rooms, for the first 24-48 hours post-treatment.
  5.  Use Brow Conditioner: Apply a nourishing brow conditioner or serum daily to keep the brow hairs hydrated and promote healthy growth.
  6.  Brush Brows Regularly: Gently brush the brows with a spoolie brush daily to maintain the desired shape and direction.

WAXING AFTERCARE:

  1.   Avoid Sun Exposure: refrain from direct sun exposure, tanning beds, or sunbathing for at least 24-48 hours post-waxing to prevent skin irritation.
  2.  Avoid Hot Baths or Showers and Sweating: skip hot baths, showers, saunas, or steam rooms for the first 24 hours after waxing to reduce the risk of irritation or infection.
  3.  Avoid Touching Treated Area: refrain from touching the waxed area with unwashed hands to minimize the risk of infection.
  4.  Only use gentle products- avoid exfoliation for first 48 hours, cleanse the treated area gently with a mild, fragrance-free cleanser and moisturizer to prevent irritation.
  5. Avoid harsh or scented products..
  6.  No Makeup on Facial Areas: refrain from applying makeup on freshly waxed facial areas to prevent clogging pores.
  7.  Avoid Swimming: avoid swimming in chlorinated pools, hot tubs, or natural bodies of water for at least 24 hours to reduce the risk of infection.
  8.  No Chemical Products: avoid using chemical-based products, such as self-tanners or perfumes, on the waxed area for at least 24 hours.


UNDERSTAND / AGREE TO THE FOLLOWING COMPLETELY 

I give permission to Refined by Riley to perform the waxing procedure and we have discussed and will hold them harmless from any liability that may result from this treatment.

I Agree

Waxing is a method of temporary hair removal which removes the air from the root. I understand that waxing may have some side effects including redness, scabbing, bruising, swelling, tenderness, flaking/ or pimples. If I experience a medical conditions, I will contact Refined by Riley and consult a physician at my own expense.

I Agree

I release Refined by Riley from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that Refined by Riley has been professionally trained to use.

I Agree

I agree to adhere to all post treatment after care including no peels, tanning, saunas for 72 hours after waxing; and all home protocols recommended by Refined by Riley that can minimize or eradicate possible negative reactions.

I Agree

I confirm, I have not had any semi-permanent make-up procedure on my Brows for at least 8 weeks.

I Agree

I confirm, I have not had any skin treatments on my face for at least 4 weeks and have not been on any medication that can affect the skin (such as Accutane)

I Agree

I confirm, I am not pregnant or are breastfeeding.

I Agree

I understand and accept that prow Lamination is an Alkaline based perm, so it is very strong. It is not suitable for clients with chemically damaged hair or extremely curly hair, as it can damage it further or cause unpredictable results. If the stylist/ artist determines my brow hairs are damaged or too curly the stylist/ artist may decide to not proceed with service.

I Agree

I understand and accept that some mild but normal symptoms may occur depending on the sensitivity of my skin during the procedure and will subside within 24 hours.

These symptoms include:

  •  (a) Mild tingling
  •  (b) Slight redness due to brushing brow hairs back and forth
  •  (c) Slightly warm in the area

I Agree

I acknowledge that I have been advised by Refined by Riley of the following potential health/medical risks associated with receiving brow lamination and/or tint and still wish to proceed with the procedures mentioned herein:

  • (a) Allergic reaction symptoms: itching, severe burning, skin flaking or peeling, inflammation, blisters

I Agree

I understand individual responses to product used for brow lamination and tint may vary - should a reaction occur, it is my responsibility to seek medical attention at my own expense.

I Agree

I will advise the brow stylist/artist of any discomfort, irritation, and/or discomfort immediately.

I Agree

I understand it is my responsibility to follow the aftercare instructions for best results.

I Agree

I understand in order to maintain the effects of brow lamination and/or tint, the procedure needs to be re-done every 4-8 weeks for maintenance.

I Agree

I understand that brows may be come unruly if touch ups are not done and am aware that brow lamination will make styling the brows easier, but will not eliminate the need for styling. Brushing and/or use of a styling gel may still be required.

I Agree


WAVIER, RELASE OF LIABILITY AND INDEMNITY

I in consideration of Riley Davidson and Refined by Riley completing the procedure(s) mentioned below, hereby release and further agree not to make any claim or demand, or commence legal action against Davidson for damages, compensation, loss or any relief whatsoever in respect of any cause or matter relating to the procedure(s). I further agree that this Agreement shall operate conclusively as an estoppel in the event any such claim, action or proceeding and may be pleaded accordingly.

I accept full responsibility for and indemnify and hold Refined by Riley, and any of its employees and/or contractors, harmless and without liability of any kind whatsoever for the responses to products used for brow lamination and tint may vary - Refined by Riley and its employees will not be held responsible for any injury or damage that may occur due to brow lamination and tint.

I further agree to hold Refined by Riley nameless and harmless from any and all damages. I release Refined by Riley from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises after the procedure. I understand I am responsible for any medical treatment I may need to receive because of getting this procedure. I accept full responsibility for these and any other complications, which may arise or resulting of getting this procedure(s), which are to be performed at my request.

Having read the above, I acknowledge that all of procedures contemplated and consented to herein have been fully explained and I fully understand the nature, scope and potential risks of the procedure(s) I am consenting to being performed and accept full responsibility for any and all results of the said procedure.

CONSENT

  •  I hereby consent to Refined by Riley performing the procedure(s) of:*
  •  Eyebrow Lamination
  •  Eyebrow Tint
  •  Eyebrow wax
  •  I hereby consent Refined by Riley taking photographs of me both before and after the procedures being undertaken by Refined by Riley and at the request of myself. It is further understood, acknowledged and herein authorized for Refined by Riley to use photographs for the purpose of compiling an album of its various current/past clients to show prospective clients, including but not limited to uploads to social media platforms such as Facebook and Instagram.

In the event that I do not wish for Refined by Riley to use said photographs in its prospective client photo album or on social media then I shall expressly state so by completing "Schedule A" attached to this Agreement and I thereafter acknowledge and consent to Refined by Riley retaining said photographs solely for its own files and internal use in development and monitoring of all services provided.

• I hereby warrant that I have read this Agreement carefully, understand its terms and conditions, acknowledge that I will be waiving certain legal rights by signing it including the rights of the minor, my spouce, chidren, parents, guardians, heirs, and next of kin, and any legal personal representatives, executors, administrators, successors, and assigns), acknowledge that I have signed this Agreement freely and voluntarily, without any inducement, assurance or guarantee, and intend for my signature to serve as confirmation of my complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement shall be deemed to have been made in accordance with the laws of the Province of the United States of America. If any provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions.

By signing this release, I understand that the permission signifies that photographic or video recordings of me may be electronically displayed via internet.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree. I hereby release any and all claims against any person or organization utilizing this material.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
How did you hear about us?

How did you hear about us? *
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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