Eyelash Extension Consent Form
Thank you for choosing iLashAmor as your lash artist! I look forward to making you fall in love with your lashes ✨
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Health History | Please check any of the following that applies to you
*
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Allergy to eyelash glue
Allergy to glycerin
Seasonal allergies
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Contact lenses (please remove before appointment)
None
Other
How did you hear about us?
*
Instagram
Facebook
TikTok
Friend/family
Other
Do you consent to being posted on any @ilashamor social media page? (Select all that apply):
*
Instagram
TikTok
Facebook
Twitter
None - Please do not post me.
What would you like to listen to during your appointment?
*
Music
Podcast
Movie/show
Frequencies/meditation music
Other
Any requests or suggestions?
Favorite music genre, podcast ideas, etc
Would you like to request a silent appointment? (No talking, just music/audio of your choice)
*
Yes
No
Have you ever had eyelashes extensions before?
*
Yes
No
If no, we would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)
Yes
No
If yes, where have you had them applied and what map (styling + length) was used?
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 the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own 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.
I certify that I am at least 18 years of age or have received explicit permission from my parent/guardian.
I, the Signee, agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
Date
*
-
Month
-
Day
Year
Date
Client Signature (Guardian Signature if minor)
*
Signee Name
*
First Name
Last Name
Technician Signature
Technician Name
First Name
Last Name
Submit
Should be Empty: