D.AllureCo. Consent Form
Hey Allure Babe! Thank you for choosing me ! I am looking forward to enhancing your beauty. It is important to read and completely understand everything this form states. Ask Question if you have any!
Name
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First Name
Last Name
Phone Number
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-
Area code
Phone Number
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you give consent to be featured on any of our social media platforms ?
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Agree
Disagree
Health History | Please check any of the following that applies to you. (If there is something I need to be aware of that is not on the list please put in the other box.)
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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?
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Yes
No
You understand the importance of speaking up and letting me know if you are uncomfortable at anytime? This includes your eyes burning , anything poking you , etc.
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Yes
You understand that It is important to communicate any concerns about my service during your appointment. Once you have left, I am unable to address them. I take pride in my work and strive for perfection, standing behind the quality of my services.
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Yes
Signature
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Sign here stating that you have complete understood the statement above
You’re fully aware that by providing your payment information for the non-refundable $15 deposit and the remaining balance at the end of the service, you authorize its use. Any chargeback may result in being blocked from booking with DallureCo and could lead to legal action.
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Yes I am aware
I “ Your Full Name” Authorized payment to DallureCo
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This is to confirm that you understand and are completely aware of forms of payments
Please agree to the terms and conditions
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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 to keep them full.
Date completed
/
Month
/
Day
Year
Should be the day of your appointment
Submit
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