Please confirm the treatments selected for this booking. To change them, update your treatment selection above.
Have you had this treatment before? *
Is this your first visit to us? *
Do you have any allergies or sensitivities? *
Select…
Yes
No
Do you currently have conjunctivitis, an eye infection, stye or contagious eye condition? *
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Yes
No
Have you had recent eye surgery, laser eye surgery or another eye procedure? *
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Yes
No
Do you have swelling, cuts, eczema, dermatitis or broken skin around the eyes? *
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Yes
No
Are your natural lashes currently very brittle, damaged or shedding excessively? *
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Yes
No
Do you wear contact lenses? *
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Yes
No
Do you have eczema, psoriasis, dermatitis, acne, rash or infection in/around the brows? *
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Yes
No
Are there cuts, abrasions, scabs, swelling, sunburn or broken skin around the brows? *
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Yes
No
Have you recently used retinol, tretinoin, acids, peels or exfoliating products around the brows? *
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Yes
No
Are your brow hairs currently very dry, brittle, damaged or shedding excessively? *
Select…
Yes
No
Have you ever reacted to lash/brow tint, lifting/lamination products, adhesive or hair dye/PPD? *
Select…
Yes
No
Have you completed the required patch test for the products being used? *
Select…
Yes
No
Have you had redness, itching, swelling or another reaction since the patch test? *
Select…
Yes
No
N/A
Patch test date
Patch test result/details
Have you had a lash lift or brow lamination within the last 6 weeks? *
Select…
Yes
No
I confirm the information I have provided is accurate and I have disclosed relevant health conditions, allergies and medication. *
Select…
I agree
I do not agree
I understand lash lift and brow lamination use chemical products and temporary redness, irritation, sensitivity, swelling or dryness can occur. *
Select…
I agree
I do not agree
Emergency contact name
Emergency contact number
Heart condition / pacemaker / circulatory problem *
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Yes
No
High or low blood pressure *
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Yes
No
Diabetes / blood sugar disorder *
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Yes
No
Epilepsy / seizures *
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Yes
No
Asthma / breathing condition *
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Yes
No
Blood clotting disorder / easy bruising *
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Yes
No
Autoimmune condition *
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Yes
No
Cancer / chemotherapy / radiotherapy *
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Yes
No
Kidney or liver condition *
Select…
Yes
No
Thyroid or hormonal condition *
Select…
Yes
No
Neurological condition *
Select…
Yes
No
Skin condition (eczema, psoriasis, dermatitis, etc.) *
Select…
Yes
No
Cold sores / herpes simplex *
Select…
Yes
No
Active infection, fever or contagious illness *
Select…
Yes
No
Recent surgery / hospital treatment *
Select…
Yes
No
Metal implants / pins / plates *
Select…
Yes
No
Scarring problems / keloid scarring *
Select…
Yes
No
Loss of sensation / neuropathy *
Select…
Yes
No
Fainting / dizziness *
Select…
Yes
No
Any other medical condition *
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Yes
No
Details of any YES answers, including dates where relevant
Latex allergy/sensitivity *
Select…
Yes
No
Adhesives / plasters allergy/sensitivity *
Select…
Yes
No
Local anaesthetic / numbing cream allergy/sensitivity *
Select…
Yes
No
Hair dye / PPD allergy/sensitivity *
Select…
Yes
No
Tint / lash or brow products allergy/sensitivity *
Select…
Yes
No
Skincare / cosmetics allergy/sensitivity *
Select…
Yes
No
Metals / nickel allergy/sensitivity *
Select…
Yes
No
Food allergies *
Select…
Yes
No
Other allergy/sensitivity *
Select…
Yes
No
Please list allergy/sensitivity and reaction experienced
Prescription medicines *
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Yes
No
Over-the-counter / non-prescription medicines *
Select…
Yes
No
Antibiotics *
Select…
Yes
No
Blood thinners / anticoagulants / aspirin *
Select…
Yes
No
Steroids *
Select…
Yes
No
Retinoids / isotretinoin / prescription acne treatment *
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Yes
No
Diabetes medication *
Select…
Yes
No
Hormonal medication / contraception / HRT *
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Yes
No
Antidepressants / psychiatric medication *
Select…
Yes
No
Photosensitising medication *
Select…
Yes
No
Herbal remedies *
Select…
Yes
No
Vitamins / minerals / supplements *
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Yes
No
Topical medicated creams *
Select…
Yes
No
Other medication or treatment *
Select…
Yes
No
List ALL medicines, creams, injections, vitamins, herbal products and supplements (dose/reason if known)
Started, stopped or changed any medication in the last 3 months? *
Select…
Yes
No
If yes, medication change details
Pregnant / possibly pregnant *
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Yes
No
Breastfeeding *
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Yes
No
Trying to conceive / fertility treatment *
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Yes
No
Recent birth / pregnancy loss *
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Yes
No
Feeling unwell today *
Select…
Yes
No
Recent vaccination *
Select…
Yes
No
Pregnancy/health details
Open cuts, wounds, bruising or broken skin in treatment area *
Select…
Yes
No
Active rash, infection, inflammation or sunburn *
Select…
Yes
No
Recent tanning / sunbed / self-tan *
Select…
Yes
No
Recent waxing, threading, depilatory cream or epilation *
Select…
Yes
No
Recent chemical peel / microneedling / laser / IPL *
Select…
Yes
No
Recent Botox / dermal filler / injectable treatment *
Select…
Yes
No
Recent facial surgery / dental work (if facial treatment) *
Select…
Yes
No
Permanent makeup / tattoos in treatment area *
Select…
Yes
No
Implants or devices in treatment area *
Select…
Yes
No
Previous adverse reaction to beauty/aesthetic treatment *
Select…
Yes
No
Please give dates/details of any YES answers above
First time having this treatment? *
Select…
Yes
No
Main concern / desired result
Previous reaction/complication? *
Select…
Yes
No
If yes, please explain
Smoke / vape *
Select…
Yes
No
Regular alcohol use *
Select…
Yes
No
Regular sun exposure *
Select…
Yes
No
Use sunbeds *
Select…
Yes
No
Use retinol / acids / active skincare *
Select…
Yes
No
Wear contact lenses *
Select…
Yes
No
Exercise intensively *
Select…
Yes
No
Upcoming holiday / major event *
Select…
Yes
No
Anything else your therapist should know before treatment?
I confirm the information I have provided is true and complete to the best of my knowledge. *
Select…
I agree
I do not agree
I have disclosed all known medical conditions, allergies, prescription/non-prescription medicines, topical medicines, vitamins, supplements and herbal remedies. *
Select…
I agree
I do not agree
I will tell Beaute Corner about any change to my health, pregnancy status, medication or treatment before future appointments. *
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I agree
I do not agree
I understand completing this form does not guarantee suitability; treatment may be postponed, adapted or declined for safety or where medical clearance is required. *
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I agree
I do not agree
I understand relevant benefits, limitations, possible side effects, risks and aftercare will be explained before treatment and I may ask questions or withdraw consent before treatment begins. *
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I agree
I do not agree
I understand results vary between individuals and no specific outcome can be guaranteed. *
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I agree
I do not agree
I consent to Beaute Corner holding and processing this information for treatment, safety, record-keeping and legal/insurance purposes. *
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I agree
I do not agree
Clinical record photographs (where required for treatment records) *
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I consent
I do not consent
Marketing/social media photographs or videos *
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I consent
I do not consent