Eyelash Extensions Intake & Consent Form
Full Name
*
First name
Last name
Cell Phone Number
*
Format: (000) 000-0000.
Do you agree to allow GET FETCH’D to send reminder texts for appointments?
Yes
No
I grant permission to Get Fetch’d to use my before and after photos for marketing or examples of my technicians work
*
Yes
No
I release GET FETCH’D 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. 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.
*
Initial
I acknowledge and understand that GET FETCH’D does NOT OFFER REFUNDS or EXCHANGES for any services provided.
*
Initial
I acknowledge GET FETCH’D does their full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION policies that are also non-refundable agreements of service. If you cancel or reschedule 24 hrs or less before your appointment, you’ll be charged HALF the amount of your service. Third offenses & NO CALL NO SHOWS will result in being charged the FULL appointment amount. (If paid through venmo, a request will be sent, and will need to be paid before setting another appointment). All deposits are non-refundable and will go towards these charges and a new deposit will need to be made for another appointment. While things may happen, it is advised to book your appointments appropriately.
*
Initial
Eyelash extensions require on-going maintenance (similar to a nail service). Fills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time, or if I have less than 40% of my eyelash extensions, it may result to an incur (higher) service cost as a full-set.
*
Initial
Is this your first time having Eyelash Extensions?
*
Yes
No
Do you wear Contacts?
*
Yes
No
Do you often rub, pull or pick your lashes for any reason?
*
Yes
No
Do you have a severe eye illness or are you being treated for an eye injury?
*
Yes
No
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.
*
Side
Stomach
Back
Are you pregnant?
*
Yes
No
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 as long. Please come to your appointments with no eye-makeup.
*
Please initial you read and understand the above.
Do you use lash growers such as Lattice or another other lash serums? It is recommended to discontinue use of these type of products 2 weeks before your service and discontinue use while you are wearing your lash extensions. Some contain oils/steroids and will shorten the duration of your extensions. There is eye-lash extensions approved products for your natural lashes that we can recommend while you have extensions.
*
Yes
No
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition
Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction.
*
Yes
No
Have you had Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service. Consult your doctor (*a doctor’s note may be required)
*
Yes
No
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.)
*
Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may not have lash extensions last long due to either of these
*
Yes
No
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 (*a doctor’s note may be required)
*
Yes
No
I further understand that in some cases as part of the procedure irritation and discomfort could occur. I agree that if I experience any irritation or discomfort with my eyelashes I will contact GET FETCH’D (and may have my eyelashes removed immediately, free of charge, for my benefit). I will also seek medical attention at my own expense.
Initial
I understand that lash extension services have some inherent risk of irritation to the orbital eye area, and could result in stinging, burning, blurry vision, and potential blindness should be adhesive or primer enter the eye or should an allergic reaction occur.
Initial
By signing this agreement, I consent to the placement and/or removal and retouched of eyelash extensions by GET FETCH’D.
Inital
I understand and agree to the after care instruction provided to me by my technician. Failure to follow these instructions may cause my eyelash extensions to fall out and/or decrease the time the lashes won’t last. I further understand that there are multiple variables that can contribute to the fall out of my eyelash extensions and/or decrease the time the lashes won’t last (including but not limited to lifestyle, medications, climate, etc).
Initial
I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.
Inital
This agreement will remain in effect for this procedure in all future follow up appointments conducted by GET FETCH’D. I under stand that this consent agreement is legal and binding. I have read and fully understood all information in this agreement. I consent to the agreement and to the eyelash extension application procedure. If any of the information has changed in the future, I will inform GET FETCH’D in writing.
*
By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.
Client signature
*
Sign date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: