Personalised Lash & Brow Services | Beauty Barn Turvey, Bedford

First name:*

Surname:*

Contact Number:*

Address:*

Postcode:*

Doctor's Name:*

Surgery Name and Address:*

I am aware that the Beauty Barn may wish to contact me for follow up appointments, details of other treatments, or for marketing purposes and I consent to my contact details being used for these purposes. I also agree with prior consent for any before and after pictures to be used*.

I allow the website to collect and store the data I submit through this form*

Medical History

The Beauty Barn wishes to provide not only the highest quality service, but also the safest possible conditions for you to receive your treatment. For us to maintain this standard we need to know of any existing medical conditions or medications you may have taken or are currently taking. This determines any contra-indications you may have to treatments and allows us to advise accordingly.

Please tick if you have used or had any of the following in the last 3 months:

Anti Ageing Treatments

Steroid Creams

Skin Peels or AHA’s

If you answered yes to any of the above conditions or treatments please give further details:

Are you pregnant?

Yes

If yes, how many weeks?

Client Declaration

I hereby authorise the Beauty Barn to perform upon myself the Eyelash/Brow treatment*

Yes

I confirm all information I have given is correct*

Yes

I confirm I wish to go ahead with the treatment and I have had no reaction to the Eyelash tint used or the LVL Lash products*

Yes

I confirm I have fully understood the aftercare instructions*

Yes

I confirm I have had a patch test 48hrs before my treatment*

Yes

I agree that my information can be kept and that it will be held strictly confidentially under the Data Protection Act as required by my insurance and law.*

Yes

Signed:

Date:*

SUBMIT

Beauty Barn Turvey

Eyelashes and Eyebrows Form

Medical History

Client Declaration

Thank you!

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