Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
*
example@example.com
Occupation
Referred by or where you found FWLD:
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Please list name of person that referred you or social platform
Are you over 18 years old?
Yes
No
Is this your first time having Eyelash Extensions?
*
Yes
No
Do you currently have lash extensions on right now? Please let FWLD know if you currently have them on. A removal would need to be booked with a full set.
Yes
No
Have you ever had a reaction to eyelash extensions? (Swelling, redness, soreness, long term burning)
What are you having lash extensions applied for?
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Special occasion
Daily wear
Do you wear Contacts?
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Yes
No
Do you often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have a severe eye illness or are you being treated for an eye injury?
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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. If you side sleep, that sides eye will be effected the most. You also never want to sleep with pillows/blankets on yours face as it will bend the lashes- sleep eyemasks are for this.
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Side
Stomach
Back
Are you pregnant?
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Yes
No
Are you able to lay on your back for 2 - 3.5 hours depending on service to have your lashes applied?
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Yes
No
As long as you have your lashes, you agree to the daily aftercare of keeping lashes healthy. FWLD will go over aftercare and educate you on how to take care of your lashes. You agree to follow all aftercare instructions to best maintain the lashes and your eye health. Oil based products, mascaras and liners will loosen the adhesive from the bond to name a few. Please come to your appointments with no makeup, it can effect your retention outcome.
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Please initial you read and understand the above.
Eyelash extensions require on-going maintenance (similar to a nail service). Fills are recommended approximately every 2 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full set. Anything after 14 days is a full set. I also agree that if 50% of my lashes aren’t at fill appointment that I may receive an up charge or charged for a full set.
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Initial
I grant permission to Fort Worth Lash Dolls to use my before and after photos for marketing or examples of my work.
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Yes
No
I agree to book a removal and have the lash extensions professionally removed when you no longer want to continue the use of wearing them.
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Yes
No
I release Fort Worth Lash Dolls from any and all liability associated with this service. 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 and certified to use. This service has many variables due to lifestyle, moisture, 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.
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Initial
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition.
This service may use adhesive tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur. Are you allergic to adhesives (glues, tapes, band aids, etc)?
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Yes
No
Do you have seasonal allergies? Allergies can cause you to itch your eyes which will result in premature fallout or cause picking/rubbing lashes.
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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.)
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Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions can cause issues with lash retention. Anything hormonally related can mess with hair cycles and health condition of the natural lashes.
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Yes
No
Blepharoplasty or other eye condition or surgery in the last 6 months? Blepharoplasty, eye surgery or conditions may have sensitivity to eye-lash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service.
*
Yes
No
I agree and understand that FW Lash Dolls & the Lash Technician have no way of knowing if the client is allergic to the products or materials being used in any eyelash service, though we do use sensitive eye products to ensure comfort, every client is different. FW Lash Dolls does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. By initialing you are also taking full responsibility if you decide personally to receive services anyway without notifying the technician of any risks to protect your health and safety.
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Initial
I acknowledge FW Lash Dolls does their full effort to fulfill my appointment 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 or reschedule 48 hrs within your appointment time, you forfeit your deposit & will need to make another for an additional appointment. Second cancellation offense, you will be charged the full appointment amount. If you cancel often, you will be no longer able to book with FW Lash Dolls. While things may happen, we advise appropriately booking.
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I acknowledge and understand that Fort Worth Lash Dolls DOES NOT offer refunds. FW Lash Dolls will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment. I also acknowledge that if I have any issues with my lashes, I will notify technician within 3 days of the appointment - after following all aftercare guidelines.
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Initial
I acknowledge and understand that all policies and pricing are subject to change and it is my responsibility to keep up on IG for any changes.
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Thank you for taking the time & signing the consent form, its much appreciated. Signing below releases all liability, and states that you understand all terms and policies related to your lash experience.
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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
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-
Month
-
Day
Year
Date
Client signature
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I'm Ready Girl! XOXO
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