Lash/ Brow Lifting

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Are you at least 18 years of age? *

Have you ever had a Lift before? *

Have you ever had a reaction to the following:

Hair dyes Mascaras Under eye pads Adhesive Medical Tape

Do you wear contact lenses? *

Are you currently/ or have in the past 6-months undergone chemo-therapy? *

Are you pregnant? *

I have provided all the information above truthfully and to the best of my knowledge. I understand that not providing the right information can affect my results and safety during this procedure. I consent to receiving services and do not hold lifted beauty or it's collaborating parties liable for any contraindications.

1. I am consenting to receive a Lash or Brow Tint/ Lash or Brow Lift today.

2. I understand that improper aftercare can affect my results to my lash lift.

3. I understand that my technician cannot predict my exact results based on my lash health, lash cycle, at home care, etc.

4. I understand if I have worn waterproof mascara in the past 48-hours, my lashes may not lift.

5. I understand that for the first 24-hours I cannot do the following: get my brows/ lashes wet, excessive sweating, steam room, swimming, applying makeup to the areas treated, sleeping on face.

6. I understand that if I have had this treatment in the past 4-weeks, my lashes and/ or brows may be over processed.

7. I understand that for the health of my lashes and brows, a protein aftercare treatment is recommended. Ask your technician on products recommended.

8. I understand that refunds are not given on services rendered.

9. I understand that a patch test for product is not always valid and can not predict if I will have a negative reaction.

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