Eyelash Extensions Consent Form

Client Name *

First NameLast Name

Phone Number*

Area CodePhone Number

Referred by (optional)

First NameLast Name

Lash extensionsBrow lamination + tint

YesNo

If so, specify any reactions or sensitivities*

Do you have any allergens? If so, specify:*

Any eye problems/surgeries in the last 4 weeks? *

YesNo

EYELASH EXTENSION CONSENT

I UNDERSTAND THAT THIS PROCEDURE REQUIRES SINGLE SYNTHETIC LASH HAIR TO BE GLUED TO MY OWN NATURAL EYELASHES. I AGREE TO HAVE EYELASH EXTENSIONS APPLIED TO MY NATURAL LASHES AND/ OR REMOVED AND RETOUCHED.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO KEEP MY EYES CLOSED & BE STILL DURING THE ENTIRE PROCEDURE THAT MAY TAKE A FEW HOURS, UNTIL MY EYELASH TECHNICIAN ADDRESSES ME TO OPEN MY EYES.

I UNDERSTAND THAT IF I REQUEST APPLICATION OF EYELASH EXTENSIONS BEYOND THE RECOMMENDED APPLICATION ADVICE OF THE CERTIFIED EYELASH TECHNICIAN I DO SO AT MY OWN RISK.

I UNDERSTAND THAT SOME RISKS OF THIS PROCEDURE MAY BE BUT NOT LIMITED TO EYE REDNESS & IRRITATION. THE FUMES FROM THE ADHESIVE MAY CAUSE MY EYES TO TEAR UP IF I OPEN MY EYES.

I UNDERSTAND THAT THERE IS A RISK OF AN ALLERGIC REACTION TO LASH EXTENSIONS. I AGREE IF I EXPERIENCE ANY REACTION I WILL CONTACT MY CERTIFIED EYELASH TECHNICIAN AND IT MAY BE NECESSARY TO HAVE THE EYELASH EXTENSIONS REMOVED.

I AGREE TO DISCLOSE ANY ALLERGIES THAT I MAY HAVE TO LATEX, SURGICAL TAPES, CYANOACRYLATE, VASELINE, ETC.

I UNDERSTAND THAT I AM REQUIRED TO FOLLOW THE EYELASH EXTENSION CARE INFO IN ORDER TO MAINTAIN THE LIFE OF THESE EXTENSIONS.

I UNDERSTAND AND ACKNOWLEDGE THAT IF PROPER AFTERCARE PROCEDURES ARE NOT FOLLOWED, AND/OR IF AN ALLERGIC REACTION OCCURS, THE EYELASH TECHNICIAN IS NOT RESPONSIBLE, THEREFORE NO REFUND WILL BE ISSUED.

I UNDERSTAND THAT BECAUSE OF THE NATURAL LASH CYCLE WEAR AND TEAR, I WILL NEED TO MAINTAIN MY EXTENSIONS WITH TOUCH UP APPOINTMENTS USUALLY RECOMMENDED ABOUT EVERY 2 TO 3 WEEKS TO KEEP THEM FULL.

I AGREE THAT BY READING & SIGNING THIS CONSENT FORM, I RELEASE ADORN ARTISTRY STUDIO FROM ANY CLAIMS OR DAMAGES OF ANY NATURE.

I AGREE THAT I READ & FULLY UNDERSTAND THIS ENTIRE CONSENT FORM.

I AM OF SOUND MIND & FULLY CAPABLE OF EXECUTING THIS WAIVER FOR MYSELF.

I GIVE ADORN ARTISTRY STUDIO PERMISSION TO SHOW MY BEFORE & AFTER PHOTOS OF EYELASH EXTENSIONS TO OTHER POTENTIAL CLIENTS UNLESS SPECIFIED OTHERWISE.

I HAVE READ & COMPLETED THE EYELASH EXTENSION INTAKE & CONSENT FORM IN ITS ENTIRETY, & HAVE ANSWERED EVERYTHING TO THE BEST OF MY ABILITY. I HAVE BEEN INFORMED OF POTENTIALLY HARMFUL OR NEGATIVE SIDE EFFECTS THAT MAY BE CAUSED BY THE APPLICATION AND/OR REMOVAL OF EYELASH EXTENSIONS.

I CONFIRM & AGREE THAT I WISH TO ENGAGE THE SERVICES OF ADORN ARTISTRY STUDIO TO APPLY EYELASH EXTENSIONS.

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