Lash Procedure Consent & Intake

Date

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

I authorize Embe Studio and all of their associates to provide and apply the following services and or services: semi-permanent eyelash extensions/ brow henna/ lash & brow lift & tint/ waxing /lash extension removal/ hybrid brows. In order to minimize risk of injury, I understand that it is my responsibility to lie or sit completely still for the entire procedure or until otherwise directed by the technician. I have been fully informed regarding the methods and procedures used in the application and aftercare recommendations. All risks and potential complications, including but not limited to, redness, irritation, and allergic reactions to either the adhesive, eye pads, or any other products used have been fully disclosed to me. I certify that I understand these risks and potential complications, and that I knowingly and voluntarily consent to the application or removal for any of the services listed above.

If at any time I feel uncomfortable during the procedure, I agree to immediately notify the the technician. The technician will see to remedy the problem, including ending the session if it is deemed prudent by the technician.

I acknowledge that there are no guarantees or promises regarding the appearance or longevity of any service, but that Melyssa and Embe Studio and any associates will always strive to provide a high level of service and aim to provide the desired outcome while also keeping the health and safety of the eyes, eyelashes, and brows in mind.

I herby certify that I have disclosed all conditions regarding my health history, and past reactions to products, treatments and medication I am currently or recently using.

I understand and consent to having my eyes closed and covered for the duration of up to 3+ hour procedure. Times may vary depending on the type and number of eyelashes applied.

I understand that talking and chewing gum during the application of lash extensions can make the application process difficult, as well as can push the protective eyepads/tape into the eye area. This can cause eye irritation, eye pain, watery eyes, fluttery eyes, chemical burn and poor lash placement. I understand that talking and movement should be avoided for my comfort and safety. I also understand that talking and movements are a disruption to the technicans workflow and may impede the quality or retention of the work

I understand that once eyepads and tape are applied, I will remain with my eyes closed for the duration of the service. Opening eyes after tape and pads are applied will disrupt placement and can lead to bruised sclera, chemical burn or discomfort.

I understand that in rare occasions there are risks associated with having artificial eyelashes applied or removed, or with lash lift and or tinting or brow wax, henna & tint and dye and lamination. 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 eyes, lashes or brows, that I will contact Melyssa at Embe Studio.

I acknowledge that the natural lash cycle is sixty to ninety days. In a healthy normal undisrupted lash cycle, when one lash falls out, there is another lash growing in. I, therefore, understand that I will need regular fills, every ONE to THREE weeks, to keep my lashes looking beautiful and ensuring optimal lash integrity and health. I understand that variables, including the natural lash cycle and home care, will influence the longevity of eyelash extensions. Embe Studio recommends fills every 2 weeks. I understand that lash extensions are a high maintenance luxury service and require a lot of time and financial commitment. If you are not able to upkeep extensions it is advisable to receive a removal. Not receiving proper fills/ following aftercare, or letting your lashes grow out to fall out can cause permanent damage to your natural lashes.

I understand that in order to be considered a lash fill appointment, I must have 40% or more lash extensions remaining. Mini fills are only for filling in gaps in the lashes and must be booked within 7 days from your previous appointment. Arriving with less than 40% of lash extensions remaining will be charged as a full set and a sooner fill will be required. If a new set is required you will be charged as such. If you are unsure if you are a proper fill candidate, please reach out to your technician.

When booking for 3+ weeks between appointments, you must be booking in for new sets even if you appear to have 40% or more extensions remaining. Natural lashes have a growth and shed cycle, and once the lash extensions have grown out 2+mm from the base they need to be removed and a new extension placed. Failure to not schedule regular maintainece appointments can result in damage to your natural lashes. Fills are typically recommended every 2 weeks.

Do you experience allergies?

If yes, please explain:

Do you have oily skin/combo skin?

If yes, please explain:

For lash extensions- I agree to avoid steam from showers, saunas, baths, dishwashers and swimming pools, tanning beds, and touching of the lashes for the first 24 hours following the lash application

I agree to avoid getting lashes wet for the first 24 hours following my lash extension application

I agree to avoid direct heat to my lashes as this can singe and in extreme cases melt the lashes. Examples are- ovens, hot dishwasher steam, blow dryers, firepits, BBQs and smoking.

For lash lift and tints- I agree to avoid steam from showers, saunas, and swimming pools, avoid tanning beds and make-up for the first 24 hours following the lash procedure

For brow henna, tint or dye, lamination or hybrid brows- I agree to avoid steam from showers, saunas, and swimming pools and avoid tanning beds for the first 12-24 hours following the application.

For hybrid brows- it is advisable to refrain from spray tanning 24 hours before or after brow appointment.

For waxing- it is advisable to refrain from using any exfoliating products/ treatments or active skincare ingredients within 7 days prior to the appointment. Examples are retinol, tretinoin, chemical peels, dermaplaning, lasers etc. Doing so can result in skin lifting, bruising or grazing

For lash extensions I agree to avoid oil-based skincare, mascara and cleansing products. I understand that water-based oil-free products are approved. I understand that oil-based products, including oil-based eyeliner, will affect the adhesion and cause lashes to fall off prematurely.

I understand that avoiding all mascara, including "Extension Safe Mascara" is recommended by Embe Studio. I understand mascara will interfere with the adhesive bond with disastrous results. Wearing mascara or eyeliner on bottom lashes/waterline is not recommended and will cause premature lash extension fallout. Makeup including eyeshadow and mascara or eyeliner (including on the bottom lashes) can cause retention issues and buildup in the lash line. Using any kind of makeup or products in the eye area with void Embe Studio's Lash Guarantee.

I understand that Embe Studio is a conservative technician in regards to procedures, processing times or styles/ lengths/ weights of lashes. Melyssa and associates will use best judgement and at own discretion to provide a safe service.

I agree to inform all service providers regarding my semi-permanent eyelash extensions/ lash lift and or tints/ brow henna/brown tinting when going for facial work. I understand that caution is recommended when having services such as lasers, chemical peels, hydroxyl treatments, or any other acidic substances applied.

I agree to keep my lash extensions brushed with a clean lash wand once per day. I understand that touching my lashes with my fingers has the potential to introduce germs, oil, and bacteria to the eye area and can result in poor retention, breakage of lashes, and infection.

I understand that it is not recommended to brush wet lashes. Allow lashes to fully dry before brushing. Brushing the lashes once a day is sufficient. Over brushing can break the adhesive bond and cause poor retention.

I agree to avoid the use of eyelash curlers (heated and non heated) and chemicals such as lash perms while I have lash extensions or a lash lift.

I agree to use only recommended products on my eyelash extensions and fully understand that careful maintenance is also required.

Please check all that apply and are relevant. I am informing my technician of the following:

If you checked any of the previous boxes- please elaborate here:

I allow permission for photos to be used on social media, for advertising and or training purposes.

I understand there are no refunds or partial refunds offered for services provided.

I understand that payment is required in full at the end of the service provided. Acceptable methods of payment are Cash, Debit, Credit or Email Money Transfer to Embestudioab@gmail.com. There is a late payment fee of $10 per day of late payment. No exceptions.

I understand that cancellations must be made with minimum 24 hour notice. If you have not arrived for your appointment and are 15 minutes late, your appointment is then considered a No Show Cancellation. Late cancellation/ No show will be responsible to pay 100% of the service fee, and must be paid prior to rescheduling. Please be mindful when needing to cancel or reschedule and let me know as soon as possible so Embe Studio is able to accommodate clients on the waitlist. Clients who reschedule within 24 hours of appointment will be required to pay a $20 rescheduling fee. Clients with 2 consecutive reschedules will be required to pay for their appointment at time of booking.

I understand that all afterhours have an additional fee applied to the service fee. The afterhours fee will be discussed prior to booking.

I understand that Embe recommends no mascara , eyeliner or strip lashes for AT LEAST 2 days prior to appointment. Even when washed, mascara, mascara residue, strip lash glue and strip lash glue residue can leave a film on your natural lashes. Please arrive to all appointments with a clean bare face. Freshly washed with no makeup, moisturizers or products. I understand that the lash guarantee is voided if lashes are not clean at the time of your appointment. For full guarantee policy, please visit www.embestudio.ca. Lash Guarantee is granted at your technicians discretion.

I understand that normal regular loss and shedding is 1-7 lashes per eye per day. I have the knowledge of proper aftercare required in regards to homecare, as well as regular lash fills. If there is irregular shedding because of error in application, I understand it will occur within the first 48 hours after the lash appointment. I agree to not touch, pluck or rub my eyes while wearing lash extensions. I understand that my lashes may shed unevenly because of sleep habits, how my hair is parted, or because of my natural lashes growth and shed cycle. I agree to avoid talking and movement during my appointments to ensure optimal lash placement and for my own safety and comfort.

I understand that lash extensions are a luxury service that require a large commitment in time, finances and aftercare. Prebooking ahead to ensure you are booking for the appropriate time between fills. Last minute or same week/following week appointments are not guaranteed. Melyssa offers extensive booking hours and afterhours to accommodate her clientele base. Online booking is open up to 60 days in advance and is available online at www.embestudio.ca. Please refer to the online booking platform for appointment scheduling. Failure to book regular fill appointments or not following fill policy of having 40% of lashes remaining and no more than 3 weeks between set or regular fill appointments will lead to termination of the client-technician relationship.

I understand that not everyone is a good candidate for lash or brow services for various reasons- natural lash integrity, lifestyle, skincare routines, medications, hormones, inability to lie still for extended periods of time etc. I understand that my technician (Melyssa) will keep my lash and brow health in mind at all times. We agree to have a mutual understanding that if either one of us are concerned about the integrity of natural lash or brow health that discontinuing future treatments- whether permanent or only temporary may be recommended.

BY COMPLETING THIS CUSTOMER WAIVER AND LIABILITY AGREEMENT, I THE CLIENT NAMED HERE CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE EMBE STUDIO AND ITS DIRECTORS, OFFICERS, OWNERS, EMPLOYEES, AGENTS AND REPRESENTATIVES FROM ANY AND ALL CLAIMS FOR DAMAGES OR PERSONAL INJURY ARISING FROM THE APPLICAION AND USE OF SEMI-PERMANENT EYELASH EXTENSIONS OR ANY OF THE OTHER ABOVE MENTIONED SERVICES AND PROCEDURES, INCLUDING ANY DAMAGES RELATING TO KNOWN OR UNKNOWN COMPLICATIONS WHICH MAY ARISE DURING OR FOLLOWING THE APPLICATION PROCESS INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE. I FURTHER RELEASE AND HOLD WYNX STUDIO FROM ANY CLAIMS RELATING TO PRE-EXISTING CONDIIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE.

I AGREE THAT ANY DISPUTES BETWEEN EMBE STUDIO SHALL BE SETTLED BY ARBITRATION ADMINISTERED BY THE ARBITRATION ASSOSIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES, AND JUDGEMENT ON THE AWARDED RENDERED BY THE ARBITRATOR(S) MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF THE PREVAILING. PARTYS SHALL BE ENTITLED TO REASONABLE ATTORNEY FEES AND ABRITRATION COSTS INCURRED IN CONNECTION WITH ENFORCING THIS AGREEMENT.

I certify that I have read and fully understand this Customer Waiver and Release Agreement. I further certify that I have completed the Client Confidential Profile accurately and completely to the best of my knowledge, and that I understand the complications and risks described herein. I herby authorize Embe Studio and associates to provide and apply semi-permanent eyelash extensions or any of the above mentioned services or products, in accordance with the terms and conditions set forth in this agreement.

Signature

Lash & Brow Procedure Consent & Client Intake