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Glow Setters Skin Studio – Brow Treatment Waiver & Consultation Form

Brow Treatment Consent & Acknowledgment

I understand that the brow treatment(s) I am receiving may include one or more of the following: brow lamination, brow tinting or staining, waxing, and threading.

- I confirm that I have disclosed all known allergies, skin sensitivities, and medical conditions.

- I understand brow lamination involves a chemical solution to restructure the hair, which may cause dryness, breakage, or irritation if aftercare is not followed.

- I understand tint/stain products may temporarily stain the skin or cause an allergic reaction. A patch test is available upon request.

- I understand waxing or threading may result in redness, irritation, or minor skin lifting, especially when contraindicated products are used.

- I acknowledge that results vary depending on hair type, skin type, and lifestyle factors.

- I will avoid moisture, makeup, exfoliants, sun exposure, and harsh products around the brow area for at least 24–48 hours post-treatment.

- I release Glow Setters Skin Studio and its affiliates from any liability associated with my decision to receive brow services.

Waiver of Liability & Legal Release

By signing this waiver, I affirm that I am voluntarily receiving brow services at my own risk. I understand that despite proper technique and precautions, unexpected reactions or results may occur. I agree to hold harmless Glow Setters Skin Studio, its employees, contractors, and affiliates from any and all claims, damages, injuries, or losses, including but not limited to allergic reactions, infections, skin irritation, dissatisfaction, or undesired outcomes.

I understand that brow services are cosmetic in nature and not medical treatments. I certify that all information provided is true and accurate to the best of my knowledge. This waiver shall remain valid for all future brow services unless revoked in writing.

Date: November 30, 2025

First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Date of Birth
Parent or Guardian's Information
How did you hear about us?

Medical History & Skin Health 

Please check all that apply to you and provide details if applicable:
Diabetes
Skin conditions (eczema, psoriasis, dermatitis)
Hormonal imbalances
Pregnancy or breastfeeding
Allergies (latex, dyes, adhesives, wax, tint, etc.)
Recent Botox, fillers, microblading, or cosmetic procedures
Use of Accutane in the past year
Use of Retin-A, glycolic acid, or acne medications
Immunocompromised conditions
Blood-thinning medications
History of keloids or hypertrophic scarring

If any boxes are checked, please explain:

Brow Treatment History

Have you had any of the following done in the brow area in the past 6 weeks?
Brow Lamination
Brow Tint or Stain
Waxing or Threading
Botox or Filler
Microblading
Laser Hair Removal or Chemical Peel

Please list any brow products you use regularly (growth serums, pomades, etc.):
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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