Gigi Lash Extensions Waiver

Full Name:

First Name Last Name
Emergency Contact Name:
Emergency Contact Tel:
How did you hear about Gigi Lash Extensions?
Please read and answer the following questions accurately and to the best of your knowledge.
Have you ever had lash extensions applied?
Eyelash extensions require medical tape and adhesives that may contain acrylic or latex. Are you allergic to medical tape or adhesives?
Do you have frequent eye irritation, itching, or watering eyes?
Have you had eye surgery in or around your eyes in the last six months?
Do you wear contact lenses?
Although every precaution will be taken to ensure your safety and wellbeing before, during and after your application please be aware of the following information and possible risks. Please initial below:
I understand that lash extension services have some inherent risk of irritation to the eye area, including the eye itself and could result stinging and burning, blurry the adhesive enter the eye or should an allergic reaction occur. Initial: *
I understand that some irritation, itching or burning may occur on the skin if the tech comes into contact with it, but will do her best to prevent this from happening. Initial: *
I understand that this is a semi permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch ups or fill appointments are necessary to maintain the original look achieved by replacing the lashes that have fallen out. Clients require a fill every 2 3 weeks. Initial: *
I consent to "before and after" pictures for the purpose of documentation, potential advertising and promotional purposes. Initial: *
I understand that there is a strict no refund policy following this procedure. Initial: *
I understand that if I have any concerns, I will address these with my technician. I give

permission to my technician to preform the lash extension procedure we have discussed,

and will hold him/her harmless and nameless from liability that may result from this

treatment. I understand that my lash technician will take every precaution to minimize or

eliminate negative reactions as much as possible. 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 lash technician,

responsible for any of my conditions.
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