Eyelash Extension Consent Form
Thank you for choosing Kiss of Beauty Lashes. 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
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
Website
Magazine
Web search
Friend/Referral
Other
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
Seasonal allergies
Allergy to glycerin
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
Other
Have you ever had eyelashes extensions before?
Yes
No
If yes, where have you had them applied, what brand was used and when was the last time you had them applied?
Are you ALLERGIC to Cyanoacrylate? This is the main ingredient that causes the glue to bond to your natural lash.
Yes
No
Are you Allergic to flonase?
Yes
No
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 (14-21days) weeks to keep them full.
I understand that I must pay for eyelash extension service in full prior to lash application. I will not be refunded due to the intimate nature of this luxury service, the time used to perform this service and I am also responsible to pay for the products used during my service.
Once the eyelash extension set is complete and I am not 100% satisfied with the service, I have the right to receive a free eyelash extension lash removal, change or add on of anything I want to be satisfied with the set.
By booking appointment, I am agreeing that I have read and agree to all terms listed.
Date
-
Month
-
Day
Year
Date
Client Signature
Technician Name
First Name
Last Name
Technician Signature
Submit
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