Lash Extension Wavier Form

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

How did you hear about us/Referred by:*

Client, Facebook, Instagram Google

Please be aware of the following information and possible risks!

INITAL EACH OF THE FOLLOWING:

I understand that a full set of lash extensions can make the appearance of my own lashes 20-40 %thicker, and make my lashes appear 20-50% longer, and that this is determined by the state of health my natural lashes are in. *

Initials

I understand that this is a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch-up or “Fill” appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2 weeks.*

Initials

I understand that lash extension service has some inherent risk of irritation to the orbital eye area including the eye itself, and could result in stinging and burning, blurry vision and potential blindness should the adhesive enter the eye, or should an allergic reaction occur. I understand that if the bonding agent comes in contact with my eye, my eye will be flushed with water and I will be assisted in seeking medical attention.*

Initials0/3

I understand that my final result may not be what I initially envisioned and understand the health of my natural lashes ultimately determine the length that can be applied without causing further damage.*

Initials

I understand “before and after” photos will be taken for the purpose of documentation on my file. I hereby grant irrevocable consent to and authorize the use of any reproduction by Ashley Lynn Esthetics, all photographs which are taken this day of me, negative or positive proof which will be hereby attached for any purposes whatsoever, without further compensation to me. All negatives, together with the prints, video or live internet stream shall become and remain the property of Ashley Lynn Esthetics, solely and completely. *

Initials

I understand that I cannot get my lashes wet for 24 hours after application this includes sweating. I understand that I must cleanse my lashes with specifically designed lash cleanser to maintain lashes and avoid eye infections. I understand anything used other than that could compromise the retention of my lashes and I am fully responsible for that. I understand that I need to brush them once a day with the wand that I am given. I understand that any type of oil/ oil-based product used near eye area including makeup/makeup remover will cause them to come off quicker than expected. *

Initials

I understand that Ashley Lynn Esthetics only accepts cash as a form of payment for services and products.

I understand that my Credit Card was kept on file for Cancellation and no show purposes when booking my appointment that is why I filled in that information and did not actually pay for my service.

I understand that if I am a no show or if I do not give the proper 48 hour notice of canceling for ANY reason that my card will be charged the cancellation fee.(complete policies are listed on the website at ashleylynnesthetics.com)

I understand that there is NO ATM located at Ashley Lynn Esthetics. I understand that if I ever need a total before my service because I will need products as well I can reach out to Ashley and she can give me a total on anything that I need ahead of time so I am prepared.

I understand that all sales are final on products and no refunds will be issued on services rendered as it is impossible to give back time and products.

I understand that if I have any concerns, I will address these with the lash specialist. I give permission to my lash specialist to perform the lash extension procedure we have discussed and will hold him/her harmless and nameless from any liability that may result from this treatment. I understand my lash specialist will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding treatment, I will consult my lash specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I DO NOT hold the lash specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment preformed today. I understand there will be NO refunds given for services that were rendered.*

Date*

Date