Lash Surgeon Consent Form

Full Name*

Last Name*

Cell Phone Number*

Format: (000) 000-0000.

Email*

example@example.com

YesNo

I release “Lash Surgeon” 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 and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.*

I acknowledge and understand that the studio doesn’t offer refunds. The Lash Surgeon will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.*

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.*

Yes (I'm EXCITED!)No (I'm a Diva, I need them 4 EVER!)

Special occasion (Places to go.. People to see!)Daily wear (It's a LOOK necessity)

YesNo

YesN

SideStomachBack

YesNo

It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. Let's talk approved products during your appointment. Please come to your appointments with no eye-makeup.*

Please initial you read and understand the above.

The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below.

YesNo

I agree and understand that Lash Surgeon & 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. The Lash Box does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. 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.*

Thank you giving us the time to get to know YOU & signing the Consent form, its much appreciated towards your lash experience*

By signing below, I verify that I have read and understand the above statements and agree.

Signature

Sign date*

Date