Formulario de consentimiento de extensión de pestañas

1

FULL NAME* This field is required.

Name

Last name

2

DATE OF BIRTH (MUST BE 18+) I represent that I am over 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement.

Date

3

AGE * This field is required.

4

CELL PHONE NUMBER * This field is required.

5

EMAIL* This field is required.

example@example.com

6

Is this your first time having Eyelash Extensions?* This field is required.

Yes

No

7

What are you having lash extensions applied for?* This field is required.

Special occasion

Daily wear

8

Do you wear Contacts? (if so, eye contacts must be removed upon your appointment)* This field is required.

Yes

No

9

Do you often rub, pull or pick your lashes for any reason?* This field is required.

Yes

No

10

Do you have , or are you being treated for any eye illness or injury?* This field is required.

Yes

No

11

Please list any eye drops or eye medication you are currently using

12

Are you able to lay on your back for 2-3 hours to have your lashes applied?* This field is required.

Yes

No

13

Will you be able to keep your eyes completely closed for up to 2 hours? (phone use is prohibited during lash application)* This field is required.

Yes

No

14

Are you pregnant? ?* This field is required.

Yes

No

15

PLEASE NOTE USE OF OIL BASED PRODUCTS AROUND EYES SHOULD BE DISCONTINUED. It is recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. * This field is required.

Please initial and date you read and understand the above.

16

How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.* This field is required.

Side

Stomach

Back

17

Are you allergic to adhesives ( glues, tapes, band aids, etc)? (This service uses adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.)* This field is required.

Yes

No

18

Have you had Chemotherapy Treatments in the last 6 months? (Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and it is recommended waiting until they are strong enough for this service.)* This field is required.

Yes

No

19

Have you had Lasik Surgery in the past 4 months? (Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area)* This field is required.

Yes

No

20

Are you currently taking Thyroid Medications? (Thyroid medications or Thyroid Conditions may not last long due to either of these)* This field is required.

Yes

No

21

Do you wear Contact Lenses? (Contact Lenses MUST be removed prior to eyelash extensions procedures. Products may get underneath the contact lens and cause an abrasion or scratching.)* This field is required.

Yes

No

22

Do you have oily skin or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, merely it may cause them to fall out quicker. Oil removal wipes are highly recommended for my oily skin babes.* This field is required.

Yes

No

23

Step 1 ♡︎ - Consultation with yours truly to insure this service is right for you and to explain your before, during and after experience thoroughly.

Step 2 ♡︎ - Select the style of lashes you would like, to cover length, fullness and shape. If you're unsure, your lash tech will be happy to recommend what's best for you and your lifestyle.

Step 3 ♡︎ - Get Lashed Up!

Step 4 ♡︎ - Rebook for your refill in approx 2 1/2 to 3 weeks!
Just a few more things! This is to insure a great service and outcome for you.

24

I understand that eyelash extensions require ongoing maintenance (similar to a nail service). Refills are recommended approx. every 2 to 3 weeks. I understand if I go beyond this recommended time it may need a full set. * This field is required.

Initial

25

I acknowledge and understand that the studio doesn’t do Refunds. The lash tech will Do the best that he or she can to satisfied the customer. * This field is required.

Initial

26

I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.* This field is required.

Initial

27

I grant permission to use my before and after photos for marketing or examples of my technicians work.* This field is required.

Yes

No

28

I release my certified lash technician from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.* This field is required.

Initial

29

* This field is required.

By signing below, I verify that I have read and understand the above statements and agree to them. Thank you for the time you took to read, understand and agree to my consent form.

30

Sign date * This field is required.

Date

31

Client signature / Parent signature if under 18 * This field is required.