Lash Surgeon Consent Form

Full Name

Last Name

Cell Phone Number

Format: (000) 000-0000.

Email

example@example.com

I grant permission to “Lash Surgeon” to use my before and after photos for marketing or examples of my technicians work. *We will make you look BOMB!*

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.

Is this your first time having Eyelash Extensions?

Are you having lash extensions applied for:

Do you wear Contacts?

Do you often rub, pull or pick your lashes for any reason?

Do you have a severe eye illness or are you being treated for an eye injury?

How do you usually sleep? Please note, you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most. It is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.

Are you able to lay on your back for 2 - 3 hours to have your lashes applied?

Are you pregnant?

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.

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.

Are you allergic to adhesives? (glues, tapes, etc) This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a high grade glue, but can allergies still occur.

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.

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*

I have answered medical questions honestly to my knowledge.

Signature

Sign date

Date