CLIENT INFORMATION

Please fill out this form prior to your first appointment.

Your answers will better help myself to meet your needs and ensure that you have a happy and satisfying experience.

Full Name

Date of Birth

Receive 10% off for your birthday

Address

Street Address Line 2

City

Instagram (or referral if applies)

Mobile Number

Used to send out your confirmation info!Format: (000) 000-0000.

I, insert name below, have viewed the ‘READ’ highlight and agree to the booking policies & before/aftercare

I have not experienced any sickness, had any COVID symptoms, traveled outside of town, or been exposed to anyone with COVID within the past 2 weeks

Full Name

Email Address

example@example.com

I, insert name below, agree to the following policies that I’ve read ↓

• No kids or guest(s) allowed • Reschedule if you are feeling sick or have any COVID symptoms • Appointments may be rescheduled 48 hours after booking, if not you’ll need to secure your next appt. with a deposit of $20 • Please wait in your car and text upon arrival • 15 minute late will result in automatic cancellation • No refunds on services and deposits • Please set aside enough time for your appointment (up to 3 hrs) • Do not wear any eye makeup or contact lenses to appointment • Avoid caffeine & use the restroom prior your appointment as there are no bathroom uses available • Must have 40% or more lashes intact to be considered a fill • Fills are every 2-3 weeks & must be scheduled within 21 days of last appointment • Please follow up with aftercare for the best retention • Free removal if an allergic reaction occurs • If you have any concerns with a service received, let me know within 2 days & I’ll be more than happy to fix it to your satisfaction at no cost!

I, insert name below, understand and agree that if I experience any irritation with my lashes I will contact my technician and have the eyelash extensions removed immediately at no cost and consult a physician at my own expense.

Eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the client's natural eyelashes. Application and removal of the eyelash extensions, even if done properly, adhesive material or fumes may irritate the eye during or after procedure, which may require further care

I authorize certified Lash Technician Asia Ellizah to perform a service on myself. I understand the risks of eyelash extensions applied or removed carries possible complications, including but not limited to eye infection, irritation, discomfort, possible allergic reaction, or blindness may occur.

Full Name

This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I understand that this agreement is binding and that I have read and fully understand all information above. I am over the age of 18 years. If you are below the requirement of 18 years of age a parent or guardian must also sign this form.

I understand and agree to follow the aftercare instructions provided by Lizah Luxe, failure to keep up with the aftercare instructions may cause retention issues &/or fallout

Initial

I release Lizah Luxe from all liability associated with this procedure. There are no guarantees for the bonding time length of the eyelash extensions. I understand that I have been advised to follow the before & aftercare protocol from my technician to avoid any discomfort or adverse side effects after the procedure has been completed.

Initial

I understand that if I have any concerns, I will address these with my lash extension specialist. I give permission to my lash extension specialist to perform the lash extension procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my lash extension specialist will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the lash extension specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

Initial

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 extension specialist, Asia Ellizah, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed.

CLIENT CONSENT FORM

EYELASH EXTENSIONS CONSENT FORM CONTINUED