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Have you had lash or brow tinting, lash lifting, lash perming, or semi permanent mascara applied previously?YesNo If yes please provide information: Please select any of the following that apply to you: Permanent eye make-upSevere stressMicrodermabrasionUse of retinoid for skin treatmentAllergies to glycerinRecent high fever or severe illnessBlepharoplasty within last 6 monthsHormonal imbalance Thyroid diseaseChemotherapy within last 6 monthsAlopecia Iron deficiencyAllergies to adhesive or syntheticsLasik Eye Surgery within last 120 daysOily skin or hair
I have agreed to the following
• Having tint applied to my eyelashes and/or eyebrows
• I understand that in the rare occasions there are risks associated with the procedure such as skin irritation and discomfort could occur. I agree that if I experience any of these conditions with my brow and skin that I will contact a professional technician for advice and my GP to seek for immediate mdeical attention.
• Have disclosed all my medical history / allergies condition.
• I agree to follow the care and maintenance instruction provided to me by my technician, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk.
• No refunds will be given and I release MOLLYLASH BEAUTY GROUP Pty Ltd t/a MOLLYLASH and its representatives of all claims and injury, seen or unseen that may occur as a result of this procedure.
• I have read and completed this form and have answered to the best of my ability.
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