• Eyelash Lift/ Lash and Brow Tint Consent Form

  •  -
  • Although every precaution will be taken to ensure your safety and well-being before, during, and after your eyelash lift, please be aware of the following information and possible risks.

    -I understand that there are risks associated with having an eyelash lift.

    -I understand that as part of the eyelash lift procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blurriness could occur.

    -I agree that if I experience any of these conditions with my eyelashes or eyes, that I will contact my technician; if I choose to consult a physician, it will be at my own expense.

    -I understand that the instruments, tapes, cleaners, eye gel pads, adhesives, and/or removers may irritate my eyes or require a physician’s follow-up care, even though my technician utilized correct techniques and followed proper safety protocols.

    - I understand that an eyelash lift will lift my natural eyelashes. Depending on my natural eyelash length and strength, results may vary.

    -I understand and agree to the care instructions provided by my technician for the use and care of my eyelashes after the eyelash lift. I realize and accept that the consequences of failure to adhere to these instructions may cause the eyelashes to not stay as lifted as long as originally told.

    -I understand and consent to having my eyes closed and covered for the entire duration of the procedure. 

  • *If you are not 18 years of age, you will be required to have a parent or guardian present at the time of your appointment.

  • Renewed Skin and Body Cancellation policy is as follows:

    A credit card is required to book your appointment, this card holds your appointment.  In the event that you no-show or late cancel your appointment less than 24 hours before your appointment time, your card will be charged a fee.  Fees vary depending on the appointment(s) booked.  Your appointment is considered a no-show if you are 15 minutes late to your appointment.  

    Inputing your card during the booking process, does not pay for your service(s), it simply holds your apoointment.

  • I agree to the following eyelash lift care and maintenance instructions:No water can come in contact with the eye area for 24 hours after the applications.This agreement will remain in effect for this procedure and all future procedures conducted by my technician.I have read the above information. If I have any concerns, I will address these with my esthetician/technician. I give permission to my esthetician/technician to perform the eyelash lifting procedure we have discussed and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician/technician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetician/technician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician/technician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed today.By signing below, I verify that I have read and understand the above statements and agree to them.

  • Clear
  • Precautionary COVID-19 Intake form

    Due to the 2019-2020 Pandemic of the Novel Coronavirus (COVID-19) we are taking Extra Precautions. Each client will be required to fill out a health history review form. Please complete the following form honestly for the safety of your Esthetician or Massage Therapist, and all of our clients.

    Common Symptoms of COIVD-19 May Include (But not limited to):

    -Dry Cough                    - Sore Throat
    -Fatigue/Tiredness          - Body Aches/Pain
    -Fever                           - Headache
    -Shortness of Breath       - Rashes on skin

    Please Read each line carfully:

     *I Affirm that I, as well as all people in my household, do not currently have COVID-19, nor have tested positive with COVID-19 within the last 30 days

    * I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced any of the symptoms listed above within the last 14 days

    * I Affirm that, I as well as all members of my household, have not traveled outside of the country, or to any state or city that is considered a “hot spot” for COVID-19 infections within the last 30 days.

    * I understand that, because esthetics and massage involves maintained touch and close physical physical proximity over and extended period of time, there may be an elevated risk of disease transmission, including COVID-19.

    By Signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time. I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

    Your technician and Renewed Skin and Body, also agree that they abide by these same standards and affirm the same. We also affirm that we have expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable disease. We are following the cleaning procedures that the CDC recommends. A list of our cleaning procedures are available upon request.

  • Clear
  •  - -
    Pick a Date
  • Should be Empty:
Jotform Logo
Now create your own Jotform - It's free!Create your own Jotform