Lash Extension Consent

Allora Beauty Bar

Eyelash Extensions Consent Form
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Allora Beauty Bar?
Is this the first time you have had lash extensions applied?

YesNo
Do you habitually rub, pull or pick your lashes for any reason?

YesNo
Do you have, or are you being treated for any eye illness or injury?*

YesNo
If yes, please explain.
Are you currently taking any medication?
Do you have allergies?
Are you over the age of 18?*

YesNo
Authorization
• I understand the this procedure requires single or multiple synthetic eyelashes to be glued to my own natural eyelashes.

• I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelashes technician addresses me to open my eyes.

• I understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if I open them.

• I agree to disclose any allergies that I may have to latex, surgical tape, eye pads etc.

• I understand that I am required to follow the eyelash extension aftercare list in order to maintain the life of my lash extensions.

• I agree that by reading and signing this consent form, I release Allora Beauty Bar from any claims or damages of any nature.

• I agree that I read and full understand this entire consent form.
By signing this agreement, I acknowledge that I have been given the full opportunity to ask any and all questions which I might have about the eyelash extensions procedure and that all of my questions have been answered to my full satisfaction.
Signature*

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Date*

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Date
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Allora Beauty Bar

Authorization