Policy | My Site

Full Name

Phone

Services Covered by This Consent

Please check all that apply:

Full Body Waxing/Sugaring

Henna Brow Tint

Lash Lamination

Brow Lamination

Treatment Descriptions

• Waxing: Removal of unwanted hair using wax or sugar. May cause temporary redness, sensitivity, or ingrown hairs.

• Henna Brow Tint: Natural dye applied to brow hairs/skin for fuller look. May last 2-4 weeks.

• Lash Lamination (Lash Lift): A chemical solution is applied to curl/lift lashes. Tint is also applied. Lasts 6-8 weeks.

• Brow Lamination: Chemical solution used to relax and set brow hairs in desired direction. Results last 4-6 weeks.

Possible Risks/Side Effects

I understand that:

• Temporary redness, irritation, or sensitivity may occur.

• Waxing/Sugaring may cause minor swelling, scabbing, or ingrown hairs.

• Henna/tint may cause allergic reaction or uneven fading.

• Lash & Brow lamination involve chemical solutions that may cause irritation if aftercare is now followed.

• Results vary based on hair type, skin type, and lifestyle.

Medical & Allergy Information

Please check all that apply

I have allergies to dye, henna, or hair tint.

I have sensitive skin, eczema, psoriasis, or dermatitis.

I am using acne/skin medications (e.g., Accutane, Retin-A, Differin).

I am pregnant or breastfeeding.

I have had recent skin treatments(peels, laser, microblading, surgery).

I have an eye infection, stye, or skin infection near treatment area

None of the above.

Aftercare Acknowledgment

I agree to follow the aftercare instructions provided, which may include:

• Avoiding sun exposure, heat, and swimming for 24-48 hours after waxing or sugaring

• Avoiding oil-based products and excessive sweating after henna tint or lamination

• Not rubbing or wetting lashes/brows for 24 hours after lamination

Consent & Liability Release

By signing below, I confirm that:

• I have disclosed all relevant medical information.

• I understand the treatment(s) I am receiving and possible risks

• I voluntarily consent to receive the selected service(s).

• I release Kodesh Beauty and Keifer Taylor from liability for any undesired results or reactions.

• This consent applies to this and all future treatments unless revoked in writing.

Photo/Video Permission

I give permission for photos of my results to be taken and used for marketing/social media.

I do not give permission.

Client Signature & Date:

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