Eyelash Extension Consent Form
Haus of Beauty LLC
Full Name
*
First name
Last name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@gmail.com
Birthday
-
Month
-
Day
Year
How did you hear about us?
Instagram
Referred by a friend
Google
Facebook
Other
I grant permission to use my before and after photos for marketing or examples of my technicians work.
*
Yes
No
I release Haus of Beauty and the licensed technician performing the service 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 to use. This service has many variables due to lifestyle, 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.
*
Initial
I acknowledge that Haus of Beauty does their full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION POLICIES that are also non-refundable agreements of service. If you cancel 24hrs before your appointment, there is no fee associated with the cancellation. If you cancel WITHIN 24hrs of your appointment, there will be a 50% NON-REFUNDABLE FEE upon cancellation. No calls or no shows will be charged 100% OF THE APPOINTMENT AMOUNT and will not be able to book again until full amount is paid. If you consistently cancel, you will lose your privileges to book with Haus of Beauty. While things may happen, we advise appropriately booking.
*
Initial
I understand that Haus of Beauty has a late policy, in which the technician performing the service has the right to cancel/reschedule the appointment if I am more than 10minutes late. There is also a late fee if I arrive over the 10minute mark, which is an additional $20 charge.
Initial
Eyelash extensions require on-going maintenance (similar to a nail service). Fills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to a higher service cost, as a full-set.
*
Initial
Is this your first time having Eyelash Extensions?
*
Yes (I'm EXCITED!)
No (I'm a Diva, I can’t live without them!)
Do you wear glasses? If so, should the length of the extensions be suitable for the use of your glasses?
*
Yes
No
Do you have a severe eye illness or are you being treated for an eye injury?
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Yes
No
I am informing the technician performing the service of any of the following conditions by selecting:
Are you allergic to adhesives (glues, tapes, ect.)? This service may use 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.
*
Yes
No
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 we recommend waiting until they are strong enough for this service.
*
Yes
No
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. (gel pads, glues, etc.)
*
Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may not have lash extensions last long due to either of these.
*
Yes
No
Do you have Blepharoplasty or other eye condition or surgeries in the last 6 months? Blepharoplasty, eye surgery or conditions may cause sensitivity with eyelash extensions. Consult your doctor first and ask if it's safe for you to have this service
*
Yes
No
Are you pregnant?
*
Yes
No
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. 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.
*
Side
Stomach
Back
It is recommended to avoid 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 compromise the retention of your lashes. Let's talk approved products during your appointment.
*
Initial
I agree and understand that Haus of Beauty and the technician performing the service have no way of knowing if the client is allergic to some of the products or materials being used in any eyelash procedure, unless told by the client, though we do use sensitive eye products to ensure comfort every client. Haus of Beauty does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options upon request. 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 truthfully and I understand the procedure and risks accompanied with the procedure.
*
Please initial if you agree and understand the statement above
Thank you giving us the time to get to know YOU! It is much appreciated towards your lash experience!
*
By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.
Sign date
*
-
Month
-
Day
Year
Date
Client Name
*
Client Signature
This form will be reviewed by your technician prior to beginning the service.
This field is only required if you are a minor and under the age of 18.*** In the case that you are under the age of 18, parental consent is needed in order to fulfill the services requested. Please provide a legal guardian’s name and phone number below.
Name and phone number of legal guardian
Signature of Legal Guardian
Submit
Should be Empty: