Eyelash Extension Consent Form

Name

First NameLast Name

D.O.B

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Have you received Eyelash Extensions before?

Have you had permanent cosmetics applied to your eye area?

Do you wear contacts or glasses?

Are you allergic to adhesives (glues, tapes, gel pads etc.)?

I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes. I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelash technician addresses me to open my eyes. I understand that some risks of this procedure may be, but are not limited to eye redness, swelling of eyelids and irritation. The fumes from the adhesive may cause my eyes to water if I open my eyes. I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Aloe, etc.

I agree that in the event of an allergic reaction, I will not hold The Glow Bar responsible for any medical bills regarding any reactions to the service performed. I understand that if an allergic reaction were to occur, I should let my stylist know immediately. I understand that my stylist will do all things in her power to calm the reaction, including, but not limited to removing the Lash Extensions if necessary.

I understand that The Glow Bar is taking every necessary precaution regarding the COVID-19 Pandemic. I understand that facial coverings are required to enter the salon, and that it is highly discouraged for any additional guests attend my appointment. I consent that I am entering the salon at my own risk, and do not hold The Glow Bar accountable if I fall ill.

I understand the policies set in place by The Glow Bar regarding their No Show and Cancellation Policy, and consent to my card being held on file in order to hold my appointment with The Glow Bar and remain in good standing.

I certify that I have read the above consent and I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.

Signature

The Glow Bar Lash Extension Service Consent Form