Threading Consent Form
(Aesthetics)
Date:
Patient Information
- Patient Name: {{patient_first_name}} {{patient_last_name}}
- Date of Birth: {{patient_birthdate}}
- Email: {{patient_email}}
Service Selection
Please select the area(s) to be treated:
Eyebrows
Upper Lip
Chin
Sides of Face
Forehead
Full Face
About Threading
Threading is an ancient hair removal technique that uses a thin cotton or polyester thread to remove unwanted hair at the follicle level. The thread is doubled, twisted, and rolled over areas of unwanted hair, plucking the hair at the follicle level. Threading is precise and allows for clean, defined shapes, particularly for eyebrows.
Benefits of Threading:
- Precise hair removal for defined shaping
- Suitable for sensitive skin
- No chemicals involved
- Results last 3-6 weeks
- Less irritation than waxing for many clients
Pre-Treatment Questions
Please answer the following:
Do you have any of the following conditions in the treatment area?
Sunburn
Skin irritation or open wounds
Active acne or breakouts
Skin infection
Eczema or psoriasis
Rosacea
Are you currently using any of the following?
Retinoids, Retin-A, or Tretinoin
Accutane (current or within past 6 months)
AHA/BHA acids or chemical exfoliants
Contraindications
Threading may not be suitable if you:
- Are currently using Accutane or have used it within the past 6 months
- Have active skin infections, sunburn, or open wounds in the treatment area
- Have had recent chemical peels, laser treatments, or microdermabrasion (within 2 weeks)
- Have extremely sensitive skin that reacts severely to hair removal
Risks and Side Effects
Potential risks and side effects of threading include:
- Temporary redness and minor swelling (typically subsides within 30 minutes to a few hours)
- Slight discomfort during the procedure
- Temporary skin sensitivity
- Rare: ingrown hairs, folliculitis, or minor skin irritation
- Rare: allergic reaction to thread material
Aftercare Instructions
- Avoid touching the treated area for several hours
- Do not apply makeup to the area for at least 4 hours
- Avoid direct sun exposure and tanning for 24 hours
- Do not use exfoliating products on the area for 24-48 hours
- Apply aloe vera or soothing gel if redness persists
- Avoid swimming, saunas, or steam rooms for 24 hours
Consent Statements
Please initial each statement:
1. I understand the nature of threading and the expected results.
2. I have disclosed all relevant skin conditions and product usage.
3. I understand the potential risks and side effects of threading.
4. I agree to follow all aftercare instructions provided.
5. I understand that results may vary and hair regrowth patterns are individual.
Signatures
ENNU Aesthetics - Threading Services
Form Version: 2025.01
Form Complete
