EYELASH EXTENSION - CONSENT FORM

EYELASH EXTENSION - CONSENT FORM

Thank you for choosing Bella Skin
I 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 Bella Skin trained technicians. *
I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my that I will contact Bella Skin and know it may be to have the eyelashes removed. *
I understand and agree to the after care instructions provided by the Bella Skin professional. I realize and accept the consequences of failure to adhere to these may cause the eyelash extensions to fall out and/or decrease the time the lashes will last. *
I understand and consent to having my eyes closed and covered for the duration of approximately 60 - 180 minute procedure. Times may vary depending on the type and number of eyelashes applied. *
Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions *

Current use of contact lenses which I may be asked to remove during the procedure Current use of anything such as oil-containing sunscreen or moisturizers around the eyes Current use of eye drops of any kind, prescription or over-the-counter Current allergies or sensitivities History of recurrent eye or tear duct infections History of dry eyes or Sjorgen’s Syndrome Recent history of Chemotherapy
I agree to the following eyelash extension follow-up and maintenance instructions:
Should any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the eyelash extensions

No waterproof mascara No oil based products around the eye area No water can come in contact with the eye area for 24 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 Bella Skin. 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 am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.
CLIENT NAME:
CLENT SIGNATURE:

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EMAIL:
example@example.com
PHONE:
DATE:

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