Lavender Falls Face & Body Spa LLC

Client Informed Consent Form

Lash/Brow Tint




19239 Stone Oak Pkwy #201

San Antonio, Texas 78258

Phone: 210-446-0903


Online Booking Available

Treatment Consists of:

The purpose of this treatment is to darken your lashes and brows, coloring grey and giving them a more polished look. We use a FDA approved lash and brow tint that is safe and effective for the eye area.

You must remove your contacts (please have your case with you)

I understand and consent to having my eyes closed and/or covered for the duration of the procedure.

Clients Acknowledgements:

We strongly suggest not getting a lash tint and/or eyebrow tint if you: are pregnant, nursing, have chronic dry eye, conjunctivitis, damaged lashes or lashes with gaps, eye infections, trichotillomania or have extremely short natural lashes. You need to wait a year after having Lasik or blepharoplasty surgery.

Medical: I acknowledge I am not currently nor have used any of the products listed below within the time frame listed.

Pre-Treatment Acknowledgement


I am not allergic to any of the ingredients in the prescribed treatment.

      Accutane and Retinoids

*Notify your aesthetician of any medical conditions & medications (Current & within the last 90 days).

Post Treatment Acknowledgement

      For optimum results avoid water, steam, mascara, and other skin care products around your eye and/or eyebrow area for 24 hours after the application.

      I understand that there are many factors that may affect the life of the lash tint and/or eyebrow tint such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures.

Side Effects:

Possible side effects include but are not limited to:

Eye irritation, eye pain, eye itching, and discomfort.

In rare cases allergic reaction, eye infection, or blurriness could occur.

You may have a patch test at least 24 hours before your appointment if you wish.

I agree that if at any time I am uncomfortable with the treatment, I will inform the technician and she will gladly rectify the problem, including ending the session.


      I understand that any time the skin barrier is compromised; there is a small risk of infection. I will contact my aesthetician immediately should this happen.

      The Lash/Brow Tint treatment has been fully explained and any questions or concerns that I have, have been addressed.

      I acknowledge that the results of lash tint and/or eyebrow tint do vary, and that no guarantees of specific results are offered or implied, due to each individual’s unique reactions.

      I acknowledge this procedure is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.

      Photographs May be taken for comparison for future treatments for my chart.


I have read the above and understand it. My provider has answered my questions satisfactorily. I accept the possible risks and complications of the treatment.


I acknowledge that Lavender Falls Face and Body Spa has a no-refund policy on any products or service. There will be no refunds for any reason.


All services performed are without any guarantee. By continuing with service, you are confirming that you have read and understand our no refunds policy.







Lavender Falls Face and Body Spa LLC

Thank you for choosing and trusting Lavender Falls Face & Body Spa LLC for your aesthetic needs

Feel free to contact us at 210-446-0903 if you have any questions



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Signature Certificate
Document name: Tint
lock iconUnique Document ID: e94f61a480abbeabb7b5902014d8f9468a79af6b
Timestamp Audit
April 8, 2017 7:58 pm CSTTint Uploaded by Lavender Falls Face and Body Spa LLC. - lavenderfallstx@gmail.com IP