49 High Street NF 20/21 Arndale Market Manchester M4 3AH
lilybrowbar@hotmail.co.uk
Open: Mon-Sat: 09.30 - 6.30 - Sunday 11:30 to 5:30
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Form
Client Eyelash Consent Form
Body Massage Consultation Form
Facial Treatment Consultation Form
Patch Test / Allergy Patch Test Form
Laser Consultation Form
Vitamin Injection Consultation Form
Treatment Consultation Form
IV Therapy Informed Consent Form
Lily Brow Bar Form
Client Allergies & Patch Testing
Lily Brow Bar Consultation Form
Client Consultation Form
Aeshthetic Consultation Form
Contact
1618 345 033
Laser Consultation Form
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Laser Consultation Form
Laser Consultation Form
Full Name
Date Of Birth
Address
Post Code
Telephone
Email
Treatment Area
Are You Undergoing Any Medical Treatment ( If Yes Please Provide Details )
Are You Pregnant or Nursing?
Currently Using / Used in Last 6 Months, any of the Folloeing?
St John's Wort
-- Select --
Yes
No
Amiodarone
-- Select --
Yes
No
Minocycline
-- Select --
Yes
No
Anti Coagulants
-- Select --
Yes
No
Gold Medications
-- Select --
Yes
No
Oral or Tropical Steroids
-- Select --
Yes
No
Oral or Tropical Retionoids ( eg. Raacution or Relin A )
-- Select --
Yes
No
Does The Area For Treatment Have:
Wole
-- Select --
Yes
No
Air Thmark
-- Select --
Yes
No
Tattoos
-- Select --
Yes
No
Parmanent Mackup
-- Select --
Yes
No
Chemical Peel
-- Select --
Yes
No
Botox
-- Select --
Yes
No
Inyectable Fillers
-- Select --
Yes
No
Tanning Enjections or Enhancers
-- Select --
Yes
No
Any Skin Disease Or Skin Disorder (Please Specify)
Had Previous Laser Treatments?
Do You Currntly have a real or fake tan?
How Long ago was your last UV exposure?
Before submitting the form, please check in with the shop staff. Otherwise, you will need to refill the form.
Send Message
Send Message
lilybrowbar@hotmail.co.uk
1618 345 033
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