Unit 815 – Provide Threading Treatment Evidence Form College Name: College Number: Learner Name: Learner Number: Date: PERSONAL DETAILS Age group: Under 20 20–30 30–40 Lifestyle: Active Sedentary Last visit to the doctor: GP Address: No. Of children (if applicable): Date of last period (if applicable): Client Name: Address: Profession: Tel. No: Day Eve 40–50 50–60 60+ CONTRAINDICATIONS REQUIRING MEDICAL PERMISSION – in circumstances where medical permission cannot be obtained clients must give their informed consent in writing prior to treatment (select if/where appropriate): Medical oedema Skin cancer Nervous/Psychotic conditions Slipped disc Epilepsy Undiagnosed pain Recent facial operations affecting the area When taking prescribed medication Diabetes Whiplash CONTRAINDICATIONS THAT RESTRICT TREATMENT Fever Contagious or infectious diseases Under the influence of recreational drugs or alcohol Diarrhoea and vomiting Any known allergies Eczema Undiagnosed lumps and bumps Localised swelling Inflammation Cuts Bruises Abrasions Scar tissue (2 years for major operation and 6 months for a small scar) Conjunctivitis Unit 815 - Provide Threading (select if/where appropriate): Sunburn Hormonal implants Recent fractures (minimum 3 months) Sinusitis Neuralgia Sunburn Migraine/Headache Hypersensitive skin Botox/dermal fillers (1 week following treatment) Hyperkeratosis Skin allergies Trapped/pinched nerve affecting the treatment area Inflamed nerve Eye infection Treatment Evidence Form 1 Treatment to include (select if/where appropriate): Total eyebrow re-shape Eyebrow maintenance Chin Upper Lip Treatment details: (to include technique used) Mouth technique Neck technique Hand technique Client feedback: Aftercare/Home care advice given: Client’s signature……………………………………………………. Learner’s signature………………………………………………….. Unit 815 - Provide Threading Treatment Evidence Form 2