Lash Lift/Brow Lamination/Henna Brows/Lash Extensions Consent Form

1

Client Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

5

I consent to having my eyes closed and covered for the duration of the 45-90 minute procedure.* This field is required.

Yes

No

6

I wear contacts* This field is required.

Yes

No

7

I agree to have an eyelash lift, eyelash extensions, brow lamination and/or Henna Brows applied to my natural eyelashes or eyebrows. By signing this agreement, I consent to the procedure of an eyelash lift, eyelash extensions, brow lamination or Henna Brows by my technician.
I understand there are risks associated with all of these procedures.
I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.
I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.
I understand that even though my technician performs the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/brows or require a physician’s follow-up care.
I understand and agree to the care instructions provided by my technician for the use and care of my Lash Lifts/Brow Lamination/ or Henna Brows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay "lifted" as long as anticipated.
I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.

I agree to the following Post Service Procedures:

No water can come in contact with the eye area for 24 hours after the application.
Avoid makeup such as mascara, eyeliner or brow pencil for the first 24 hours.
Avoid using oil containing sunscreens, moisturizers and cleansers on lashes for the first 24 hours.

Acknowledgement and Waiver

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them.

If it is discovered that the undersigned individual has any provided false information including, but not limited to their age or parental consent status, this agreement shall be deemed null and void. The undersigned individual shall be solely responsible for any costs, damages, or expenses incurred by Brow Heaven as a result of such misrepresentation, including but not limited to legal fees and compensation for any losses suffered. Brow Heaven reserves the right to pursue all available remedies to recover said costs from the undersigned individual.

8

Date* This field is required.

Date

9

Signature* This field is required.

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