Define Beauty Studio

Define Beauty Studio

Client Liability Form
Name*

First NameLast Name
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I understand and acknowledge that there are risks involved with this treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have had the opportunity to ask questions regarding these risks and possible complications.

I also recognize there are no guaranteed results and that independent results are dependent upon age, skin conditions, lash health, and lifestyle. There is a possibility I may require further treatment of the treated areas to obtain the expected results at an additional cost.

I understand how important it is to follow all instructions given to me on post-treatment care. In the event you have additional questions or concerns regarding my treatment or suggested home product/ post-treatment care, I will consult Define Beauty Studio immediately.

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.

I understand and consent to have my eyes closed and covered for the duration of the 60-150 minute procedure.

CANCELLATIONS/ NO SHOW

Define Beauty Studio charges a 100% cancellation fee for any no-shows and a 50% fee for any cancellations within 24 hours of the scheduled appointment.

I have read and fully understand this agreement and all the information detailed above.

Check all that apply*

Wears contacts/ glassesHas a Thyroid complicationRecent history of Chemotherapy.PregnantCurrent use of eye drops of any kind, prescription or over-the-counter.Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions.History of a recurrent eye or tear duct infections.Current allergies or sensitivities to tapes or adhesives.None Apply
Signature:*

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Permission is granted to take before and after photos of my eyes / face which may be used for marketing purposes on a website, salon or class. Signature:

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Signature by parent or guardian of anyone under 18 years old:

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Should be Empty: