Name
First Name
Last Name
Eyelash Extension Consent Form
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthday
*
-
Month
-
Day
Year
Date
How did you hear about us?
*
Facebook
Snapchat
Instagram
Web search
Friend
Other
Handle of your IG, Snap, Facebook, or Person who referred you
*
please add which platform or friend who referred you.(you can add just 1 platform) EX: IG: XXX or Snap: XXX or FB:XXX
Health History | Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue, nail glue, hair glue, black carbon”coloring”
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
^ Answer here
Have you ever had eyelashes extensions before?
Yes
No
If no, we would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen & is done within a 48hr period, a lash appointment will be set up after 48hrs if there was no reaction)
Yes
No
If yes, where have you had them applied and what brand was used? If you don’t remember you can just put your last Artist’s name.
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the licensed & certified professional Grisel at Grisel Lash Artistry.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur. I understand that if I am or become allergic to the adhesive, lash extensions &/ or any lash products used on me, I will not receive a refund but I am eligible to receive a free removal of the lashes.
I understand that because of the natural lash cycle and 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.
Please agree to the terms and conditions
I give permission to Grisel Hernandez, “Grisel Lash Artistry” to show my before & after photos and/or videos to other potential clients as needed without claim (e.g Facebook, Instagram, website, etc. )
I acknowledge that I’ve been informed of potentially harmful or negative side effects that may be caused by the application or removal of eyelash extensions and hereby fully release, agree to hold harmless and forever discharge Grisel Hernandez “Grisel Lash Artistry” from all liability, demands, or claims associated with this service/procedure.
Date
*
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Month
-
Day
Year
Date
Client Signature
Submit
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