Lashedj Consent Form
Lash and Brow studio
Client Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
City
Province
Postal Code
Emergency Contact Details
**only fill out if you are under the age of 18**
If you are a minor, in case of emergency, we will contact the person below:
Emergency Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship
Signature of parent or guardian if under the age of 18
Please sign here
Previous lash experience
Are you using any of the following
Accutane
Retinols/retinoids
Face exfoliants
Eye drops
Contacts
What service are you booking for?
*
Lash Lift and Tint
Lash Extensions
Brow Lamination
Do you have any allergies to Latex?
*
If yes, please specify on the field above.
Do you have any allergies to banana's, kiwi's, strawberries, polish remover, nail polish, or Nuts?
*
If yes, please specify on the field above.
Do you usually rub, pull, or pick your lashes?
*
If yes, please specify on the field above.
Have you ever had previous irritations to lash extensions?
*
If yes, please specify on the field above.
Reason for switching Lash artists?
If you feel comfortable sharing.
Any concerns you have regarding Lash extensions and/or Lash lift and tints I should be aware of?
*
If yes, please specify on the field above.
HOW DID YOU HEAR ABOUT US?
*
Instagram.
Facebook
Friend
Other
Consent and Waiver
*
I certify that I have read this entire informed consent and I understand and agree to the information provided in the form. My questions regarding lashes have been answered. I hereby release Lashedj and Jocelyn Meersseman from all liabilities associated with lash extensions and/or Lift and tint/brow laminations.
I give permission to Lashedj to use any photos taken for instagram and/or promotional events.
I acknowledge that all information I provided in this form is true and accurate.
I acknowledge that I am coming to this appointment at my own risk. Lashedj is taking all necessary precautions regarding COVID-19 sanitary stipulations and will not be held liable for any COVID-19 related illness's .
I have read through Lashedj's Policy page on the website and understand all the policies to the best of your abilities.
Lash Technician doing your service
Jocelyn Meersseman
Ashley Wain
Signature of the Client
*
Please sign here
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: