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
(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 to include (select if/where appropriate):
Total eyebrow re-shape
Eyebrow maintenance
Chin
Upper Lip
Provide Threading Treatment Evidence Form
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Treatment details:
(to include technique used)
Mouth technique
Neck technique
Hand technique
Client feedback:
Aftercare/Home care advice given:
Pass
Refer
Assessor’s Signature.....................................................
Client’s Signature……………………………
Internal Verifier’s Signature...........................................
Learner’s signature…………………………
External Verifier’s Signature .........................................
Provide Threading Treatment Evidence Form
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