EYELASH EXTENSION CONSENT FORM & LIABILITY WAIVER
Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.
Have you ever had lash extensions applied before?
Yes
No
Are you being treated for an eye illness or injury (past 6 months)?
Yes
No
I understand that there are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes.
*
Yes
I understand that the fumes from the adhesive may cause my eyes to water if I open my eyes.
*
Yes
I understand that as part of the procedure eye irritation, pain, itching, discomfort and in rare cases eye infection may occur.
*
Yes
I understand and agree that if I experience any of these issues with my lashes I will contact my technician and have the eyelash extensions removed immediately and consult a physician at my own expense.
*
Yes
I understand and agree to follow the aftercare instructions provided by my technician. Failure to follow the aftercare instructions may cause the eyelash extensions to fall out.
*
Yes
I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for a duration of 60-180 minutes during the procedure. Failure to do so can result in burning or eye irritation, which can lead to infection, or chemical burn from the glue.
*
Yes
I acknowledge and understand that the studio doesn’t do Refunds.
*
Yes
I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 to 4 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.
*
Yes
I release my certified lash technician and Luxury Lash Lounge 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 tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decided if I am a good candidate for this service to the best of their ability.
*
Yes
Checkmark if you have any of the following conditions:
Current use of eye drops of any kind, prescription or over-the-counter
Current allergies or sensitivities
History of recurrent eye or tear duct infections
History of dry eyes or Sjorgen`s Syndrome
Recent history of Chemotherapy
Checkmark to agree to the following eyelash extension follow-up and maintenance instructions:
*
No waterproof mascara
No oil based products around the eye area
No water can come in contact with the eye area for 24 hours after the application
No tinting or perming of eyelash extensions
No pulling or rubbing of the eyelash extensions
I grant permission to use my before and after photos for marketing or examples of my technicians work.
Yes
No
By signing below, I here by release and agree to hold Luxury Lash Lounge harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Luxury Lash Lounge. If I take any steps to make a claim for damages against Luxury Lash Lounge , its agents, employees or any other released parties, I shall be obligated to pay all of my own and Luxury Lash Lounge’s attorney’s fees and costs incurred as a result of such claim.
*
YES
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 our consent form.
*
Yes
Signature
Submit
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