Eyelash Extension Consent

I blanks(Client’s name) agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional.

blanksI understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed.

blanksI understand and agree to the after-care instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out and/or decrease the time the lashes will last.

blanksI understand and consent to have my eyes closed and covered for the duration of approximately 30-180 minute procedure. Times may vary depending on the type and number of eyelashes applied.

blanks I am informing the certified eyelash extension professional of the following conditions by marking with a check:

Current use of contact lenses which I may be asked to remove during the procedureCurrent use of anything such as oil-containing sunscreen or moisturizers around the eyesCurrent use of eye drops of any kind, prescription or over-the-counterCurrent allergies or sensitivitiesHistory of an allergic reaction to eyelash extension productsHistory of recurrent eye or tear duct infectionsHistory of dry eyes or Sjorgen’s SyndromeRecent history of ChemotherapyOther medical conditions which would prohibit or compromise placement and retention of eyelash extensions

blanksI 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 4~5 hours after the application

☐ No use of pool, sauna or spa for 48 hours after the application

☐ No tinting or perming of eyelash extensions

☐ No pulling or rubbing of the eyelash extensions

This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement.

I release my technician or salon (Authentic Esthetics ) from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There is no guarantee for the bonding time of the eyelash extensions. This salon is not responsible for any technician errors. I understand the after care instructions and will do my part to maintain my eyelash extensions. I understand that there are many factors that may affect the life of the eyelash extensions such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures.

Signature

Date