Eyelash Extension Form

Eyelash Extension/Eyelash Lift Consent Form

Thank you for choosing Savvy Skin Aesthetics
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Card on file for no-show protection

Name on Card

Card number

exp. dateSecurity code

Postal / Zip Code
Health History | Please check any of the following that applies to you*

Allergy to adhesives band aid or medical tapeAllergy to surgical glue or nail glueSeasonal allergiesAllergy to glycerinEye illness or injuryBlepharitis (inflamed eyelids)Permanent eye-makeupEye liftDrugs that can cause temporary hair lossMajor surgery within last 120 days
Have you ever had a lash lift before?

YesNo
EYELASH LIFT/TINT CLIENT: Please agree to the terms and conditions

I hereby agree to have the lash lift and tint applied to my natural lashes by a certified professional.I understand that there is a chance for my lashes to not curl/lift due to strength of lash/lash stubbornnessI understand that even with a patch test there is still a potential for an allergic reaction & I agree to take on that risk.I understand that by signing this form it acts as proof & consent for today & future appointments at Savvy Skin AestheticsI understand and agree to not hold Savvy Skin Aesthetics or its contractors responsible if any sort or reaction occurs.I understand and agree to not hold Savvy Skin Aesthetics or its contractors responsible if any sort of reaction occurs.I understand that a card on file is necessary in order to hold my appointment. I agree to have my card charged a 50% fee if I cancel my appointment with less than 24 hour notice. 100% service fee will be charged for no-call, no-show. Anything with a greater than 24 hour notice (&certain exceptions) will not be charged.I agree to disclose any concerning signs of sickness (particularly related to COVID-19) to my provider BEFORE my appointment. *Fee may be waved under circumstances- Thank you forbeing considerate to the health of our providers!I agree to consent to Savvy Skin Aesthetics to post any before/after pictures on any social media site!
Client Signature*

Clear
Have you ever had eyelashes extensions before?

YesNo
Extension set you want:
If yes, where have you had them applied and were they classic, hybrid, or volume?
If no, would you like to have a patch/allergy test? (Note that a patch test does not guarantee that an adverse reaction will never happen)

YesNo
EYELASH EXTENSION CLIENT: Please agree to the terms and conditions

I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.I understand and agree to follow after care steps. I understand that incorrect or lack of after care may results in damage to natural lashes or infection & I agree to take on that risk.I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full. (Pre-booking is recommended)I understand that even with a patch test there is still a potential for an allergic reaction & I agree to take on that risk.I understand that by signing this form it acts as proof & consent for today & future appointments at Savvy Skin AestheticsI understand and agree to not hold Savvy Skin Aesthetics or its contractors responsible if any sort of reaction occurs.I understand that a card on file is necessary in order to hold my appointment. I agree to have my card charged a 100% fee if I cancel my appointment with less than 24 hour notice. 100% service fee will be charged for no-call, no-show. Anything with a greater than 24 hour notice (&certain exceptions) will not be charged.I agree to disclose any concerning signs of sickness (particularly related to COVID-19) to my provider BEFORE my appointment. *Fee may be waved under circumstances- Thank you forbeing considerate to the health of our providers!I agree to consent to Savvy Skin Aesthetics to post any before/after pictures on any social media site!
Should be Empty:

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Eyelash Extension/Eyelash Lift Consent Form