Eye Lash Extensions Intake & Consent Form
Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
Please upload a picture of your state issued drivers license or state issued ID
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I understand that pictures and videos will be taken for educational, advertising and marketing purposes.
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Initial
I release Deadly Doll Artistry and its artists from any and all liability associated with this procedure. 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, certified & licensed to use.
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Initial
I acknowledge and understand that the studio doesn’t offer refunds. Deadly Doll Artistry will not refund any fees or deposits.
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Initial
I acknowledge that there is a 24 hour reschedule/ cancellation policy. I must reschedule/cancel 24 hours before the beginning of my appointment. Cancelling or rescheduling less than 24 hours will result in a cancellation fee up to 100% of booked service.
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Initial
Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set.
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Initial
Is this your first time having Eyelash Extensions?
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Yes
No I have had them before.
Are you having lash extensions applied for?
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Special occasion
Daily wear
Do you wear Contacts?
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Yes (Please remove them prior to service)
No
Do you have a severe eye illness or are you being treated for an eye injury?
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Yes
No
Are you able to lay on your back for 3 - 4 hours (a full set) or 1.5-2 hours for a fill to have your lashes applied?
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Yes
No
Are you pregnant?
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Yes
No
I understand that a patch test can be done a week prior to my appointment and is my responsibility to book?
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I have already done a patch test with Deadly Doll Artistry.
I choose to not do a patch test and understand that I take full responsibility of any potential reactions.
I understand retention is affected by hormones, allergies, life style, and medications I may use. If I have any retention issues I must contact my artist within 72 hours (3 days) of initial appointment to qualify for a free touch up. Anything after 3 days will be treated as a regular fill at full price.
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Please initial you read and understand the above.
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition
Are you allergic to adhesives (glues, tapes, band aids, etc)? This service will use adhesives tapes, glues and gel pads that may cause an allergic reaction. I use a medical grade, formaldehyde free glue, latex free, hypoallergenic adhesive but allergies may still occur.
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Yes
No
Have you had Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service, we can also order a lash growth serum that will help.
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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 may not have lash extensions last long due to either of these
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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
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Yes
No
I agree and understand that Deadly Doll Artistry & my Lash Technician have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort, every client is different. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
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Initial
I understand that medication, hormones and stress can greatly affect my lash cycle and may lead to retention issues. Density of my lash set depends on my natural lashes. I understand there is after care that must be followed and I must prebook my appointments to avoid schedule conflicts.
Initial
Thank you giving us the time to get to know YOU & signing the Consent form, its much appreciated towards 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. By checking this box I also release Deadly Doll Artistry from any liability that results from the service booked.
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Full set deposit (nonrefundable)
This is a $35 nonrefundable deposit.
$35.00
$
35.00
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Credit Card
I (The card holder) , authorize Deadly Doll Artistry to charge my credit/debit card above for agreed upon purchases. By signing I understand I will not receive any refunds or credits for any fees paid.
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