Lash Extentions Consent Form

Date *

Date

Full Name *

First Name Last Name

Phone *

Area Code Phone Number

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

How did you hear about Fierce Beauty Boutique? *

Other/ Friend

Have you ever had eyelash extensions applied?

Yes No

Do you have any known allergies? If so, please list below.

Do you have frequent eye irritation, itching, or watery eyes?

yes no

Do you wear contact lenses?

yes no

Have you had eye surgery in or around your eyes in the last 6 months?

yes no

I agree to disclose any medical conditions including skin conditions and/or any allergies that I may have to surgical tapes, latex, gel eye pads, cyanoacrylate, Vaseline, ect.

yes no

If yes, please list below.

I understand that this procedure requires synthetic eyelashes to be glued/applied to my own natural eyelashes and it is my responsibility to keep my eyes closed and be still during the entire procedure *

I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I understand that some risks of this procedure may result in, but not limited to, eye redness and irritation. *

I understand that I am required to follow the eyelash extension care sheet in order to maintain the life of my extensions. *

Arriving late will reduce time of my service. If I am no more than 15 minutes late, I understand my appointment may need to be rescheduled. *

I release my technician and Fierce Beauty Boutique, LLC. from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application, using tools and products that the technician has been properly trained to use. *

If you currently have eyelash extensions on from another lash artist, there is a possibility that your current extensions will need to be removed and a new full set applied. Due to the unregulated nature of eyelash extension trainings and certifications, there are a lot of lash artists that have been improperly trained. At Fierce Beauty Boutique, our priority is your natural lash health and eye safety. *

You are paying for artist time, product and other expenses used to provide you with a service. No refunds will be given for services or products. Should you have any issues to occur with your lashes, please contact me within 72 hours of your appointment to discuss your concerns. This may be done so with a complimentary 45-minute express touch up if it is at the fault of application or product. Any concerns addressed after 72 hours of your last appointment, or if you failed to follow the proper aftercare instructions, will be charged at full price for the service. *

As a courtesy to Fierce Beauty Boutique, and in order to efficiently accommodate all clients, a cancellation fee of 50% service value is required. Cancellations without 24 hours notice will be charged this fee. No shows are also subject to a 50% fee to be charged to the card on file. *

I have read and completed the eyelash extensions intake and consent form in its entirety and have answered everything to the best of my ability . *

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Lash Extensions Agreement & Consent Form