Brow Tint Consent Form

A few quick things beforehand:

Arrive with clean brows — no makeup on the area.
If it’s your first tint or you’re sensitive, let us know so we can patch test.
Avoid exfoliating the brow area right before.

To keep your tint looking fresh:

Avoid wetting or rubbing the brows for 12–24 hours.
Skip oil-based cleansers and exfoliants on the brows — they fade the tint faster.
A brow tint typically lasts 3–4 weeks.

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Section A — Client Information

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Today's Date *

City

State

Postal Code

Desired shade

Emergency Contact Name

Emergency Contact Phone

I agree to receive booking confirmations and appointment reminders at my email address above. *

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Section B — Patch Test

Brow tint contains dye. A patch test is required at least 24–48 hours before your first tint to check for allergic reaction. Please confirm below.

Patch test completed — no reaction Need to schedule a patch test Returning client — tinted before with no reaction

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Section C — Photo Release

I consent to before/after photos being taken for use on social media and website.

Name preference for photos

Use my name No name Fictitious name

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Section D — Medical History

List any known allergies (incl. dyes, PPD)

List all current medications

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Section E — Brow Tint Contraindications

Please check any conditions that apply to you. If any box is checked, your technician will review before proceeding.

Known allergy or past reaction to hair dye, tint, or PPD Eczema, dermatitis, or psoriasis in the brow area Broken skin, cuts, or sunburn in the brow area Eye infection, conjunctivitis (pink eye), or stye Recent chemical peel or microdermabrasion in the area (within 2 weeks) Brow tint, henna, or lamination within the last 2 weeks Very sensitive skin or history of reaction to tint Pregnant or breastfeeding

I understand brow tint is semi-permanent (typically lasting 2–4 weeks), that results vary with skin and hair type, and that I should avoid heavy cleansing, exfoliants, and swimming in the area for 24 hours.

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Section F — Client Consent & Signature

Appointment reminders: I consent to receive appointment reminder messages via SMS. Reply STOP to opt out. Promotions: I consent to receive promotional and marketing messages from I Am Beautiful by Mia. Reply STOP to opt out.

By checking the SMS boxes above, you agree that I Am Beautiful by Mia may contact you at the number provided. This is not a condition of service.