Client Intake Form & Waiver

  • Contact Information

  • Date of birth*
     - -
  • Format: (000) 000-0000.
  • Would you like to receive promotional emails from The Lash Room?
  • How did you hear about us?*

  • Client History

  • Have you had any of the following lash treatments before? Check all that apply:*
  • Do you currently have lash extensions on?*
  • If yes, when was your last service (full set or fill):
  • Are you having lash extensions applied for?*
  • 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 most.*
  • Please check all that apply to you. (•note- some of these conditions are not suitable for lash extensions. It may be recommended to use a lash growth serum for a period first, to help strengthen your natural lashes)*
  • Do you currently use any of the following products? (check all that apply to you):*
  • Are you able to lay in a recliner with your eyes closed, for 2-3hrs to have your lashes applied?*
  • I allow photos and/or videos to be taken of my eyes and face before, during and after my service which may be used for marketing purposes.*
  • Please indicate if you'd prefer to have a patch test done 24-48 hours before your initial appointment.*

  • Authorization

  • •I understand that this service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding, and other factors. My natural lashes will be the guide to the length, curl, thickness and amount of extensions I can receive.


    •I understand that adhesive and tweezers are used by my eyes and that it is my responsibility to keep them closed and be still during my service. 


    •I understand that there are some risks, not limited to- redness, irritation and/or reaction. The fumes from the adhesive may cause my eyes to tear up if I open them. 

     

    •I will contact The Lash Room if any allergic or adverse reaction occurs, to have my extensions removed at no cost and may need to seek medical care (at my own cost). I understand that no refund will be given. 

    •I agree to follow the aftercare guide for the best life and health of my lashes. Failure to do so may cause premature loss of my lash extensions and/or damage to my natural lashes.  


    •I agree to inform The Lash Room of any health changes in the future, including pregnancy. 


    •All of my questions were answered and I understand the procedure and risks.


    •I understand that rescheduling or cancelling with less than 24hrs notice will result in a full charge of the service. 


    •I understand that The Lash Room does not offer refunds on any services or open products. Should I have issues I have 72hrs from my appointment to contact The Lash Room to discuss. A complimentary 30 minute appointment may be given if needed for light alteration or removal. After this time frame I understand that it will be considered regular service and will be at my own cost.


    •By reading and signing this form, I release The Lash Room from any and all liability associated with this, and any other procedure.

     

    •This agreement will remain in effect for all future visits.

     

    ***If you wear mascara or strip lashes, please discontinue use for at least 3 days prior to your appointment and wash lashes daily with soap. A build up of mascara or strip lash glue can interfere with the how the glue bonds. 

    ***If you are coming from another service provider, please note: Though the majority of the time there are no problems “working over” others work, on occasion a removal will be required before we can proceed. In this situation we would discuss the options and make a decision on how to move forward.

  • Consent Form

  • Today’s date *
     - -

  • •I have read the Shop Policies

     

    •I have read the Aftercare Guide

  • Should be Empty: