Lash Procedure Consent & Intake

Date

Name

First Name Last Name

Phone Number

Area Code Phone Number

Email

example@example.com

I authorize Wynx Beauty Bar to provide semi-permanent eyelash extensions, henna brows, eyebrow tint, ombre powder brows. In order to minimize risk of injury, I understand that it is my responsibility to lie completely still for the entire procedure or until otherwise directed the stylist. I have been fully informed regarding the methods and procedures used in the procedure. All risks and potential complications, including but not limited to, redness, irritation, and allergic reactions to either the adhesive or eye pads, chemicals, pigments 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 procedure.If at any time I feel uncomfortable during the procedure, I agree to immediately notify the stylist. The stylist will see to remedy the problem, including ending the session if it is deemed prudent by the stylist. I acknowledge that no guarantees or promises regarding the appearance or longevity of the eyelash extensions, ombre powder brows or henna brows, have been made. I herby certify that I have disclosed all conditions regarding my health history, medications and past reactions to products, treatments and medication I am currently or recently using.I agree to use only recommended products and proper aftercare and fully understand that careful maintenance is also required. *

Yes

For Lash Extensions -

Avoid getting lashes wet for the first 24-48 hours following my lash extension application

Avoid steam from showers, saunas, and swimming pools and avoid tanning beds for the first 48 hours following the application

I certify that I understand, and agree to comply with the following instructions with respect to care of my lash extensions:Avoid oil-based skincare, mascara and cleansing products. ONLY water-based oil-free products are approved. Oil-based products, including oil-based eyeliner, will affect the and cause lashes to fall off prematurely. Only approved Lash extension mascara is permissible. Oil-based and or waterproof mascara will interfere wit the adhesive bond with disastrous results.

Keep your fingers off your lashes. Every time you touch them you are transferring natural oils and GERMS.

Brush your lashes with a mascara wand (provided at the end of service) to groom your lashes, ideally twice a day. Eyelash shampoo is recommended.

When cleaning your lashes, use your cleansing brush and foam cleanser or your lash wand and gently brush through.

For Permanent Makeup -
Avoid contact with water other than cleansing as directed by service provider
Do not touch the healing pigmented area with your fingers, they may have bacteria on them and create an infection.
Lightly wipe the procedure site clean with a damp cloth or cotton pad before applying the aftercare. Always use a clean q-tip for application not your fingertips.
Apply the aftercare given 3 times daily until healed.
No Make-up, tinting of brows, sun, soap, sauna, jacuzzi, swimming in chlorine pools or in recreational bodies of water, direct contact with animals or gardening for 7-10 days (until the area is completely healed) post procedure and after all touch -ups. --Wait at least 2 weeks before waxing
Avoid indoor and outdoor tanning for 14 days.
Bathing instead of showering is recommended for the first 7-10 days to avoid getting your eyebrows wet.
Do not rub or traumatize the procedure area while it is healing (pigment may be removed along with crusting tissue) Aftercare General Instructions for Microblading and Powder Brows 7+ days following applications of permanent cosmetics:
Use a proper sunscreen after the procedure area has healed to prevent future fading of pigment.
Do not use products that contain AHA's on the procedure area. (Example: Glycolic Lactic acids) Always check your product labeling! It will fade the pigment.
Try to sleep on a satin pillowcase while the procedure area is healing.
If you have any concerns, please notify your physician immediately.
If you experience any itching, swelling, tenderness, elevated temperature or purulent drainage from the procedure site, contact your physician as the area may be infected and you may need to seek medical care

I acknowledge that the natural lash cycle is sixty to ninety days. 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 full. I understand that variables, including the natural lash cycle and home care, will influence the longevity of eyelash extensions.

Yes No

Do you experience allergies?

Yes No

If yes, please explain:

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

Current use of contact lenses Current use of eye drops of any kind, prescription or over-the-counter Current use of oil based products such as sunscreen, moisturizer, face wash and make-up History of recurrent eye or tear duct infections History of dry eyes Received chemotherapy in the last 6 months medical conditions which would prohibit or compromise placement and retention of eyelash extensions

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

Yes No

I understand there are no refunds offered for services provided unless otherwise stated by the technician. *

Yes

I understand that payment is required in full at the end of the service provided. *

Yes

I understand that cancellations must be made with minimum 24 hour notice. If I have not arrived for my appointment and am 15 minutes late, my appointment is then considered a No Show Cancellation; I 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 Wynx Beauty Bar know as soon as possible so I am able to accommodate clients on the waitlist. Clients with 2 consecutive reschedules will be required to pay a deposit to book their appointments. A Client who no shows will be unable to book with any Wynx affiliated studios in Alberta. Extenuating circumstances will be judged on individual merit. *

I accept the Cancellation policy described here

BY COMPLETING THIS CUSTOMER WAIVER AND LIABILITY AGREEMENT, I THE CLIENT NAMED HERE CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE WYNX LUXURY EXTENSIONS 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 LUXURY EXTENSIONS FROM ANY CLAIMS RELATING TO PRE-EXISTING CONDIIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE. *

Yes

I AGREE THAT ANY DISPUTES BETWEEN WYNX BEAUTY BAR 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. *

Yes

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 Wynx Beauty Bar 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

Clear

Lash Procedure Consent & Client Intake