Eyelash Extension Consent Form
Thank you for choosing Lashfully & Laced LLC. We are looking forward to a long and lengthy communication.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
How did you hear about us?
Website
Magazine
Web search
Friend
Other
Health History | Please check any of the following that applies to you
*
Allergy to adhesives band aid/medical tape or latex
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup or contacts
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
None
Have you ever had eyelashes extensions before?
*
Yes
No
If yes, where have you had them applied and did you have any issues?
Have you traveled in the last two weeks? If so, where?
*
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes by the certified professional. I understand all risks associated with this procedure (application/removal of eyelash extensions)will not be held liable due to any damages that occur (eg. allergic reactions) to me or my lashes.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk and no refunds are disbursed.
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.
I cerfify that all information provided on this form is true and correct to the best of my knowledge.
I understand this procedure and consent to receive services.Photo Release: I consent to the technicians use of my before & after photos for business purposes.
ALL OF MY QUESTIONS AND CONCERNS HAVE BEEN FULLY ADDRESSED PRIOR TO SERVICE.
Date
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Month
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Day
Year
Date
Client Signature
Technician Signature
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