Eyelash Extension Consent and Waiver of Liability
  • Eyelash Extension Consent & Waiver of Liability Form

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  • Client History Intake

    Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.
  • The following conditions may not be suitable for eyelash extensions. Please contact me to discuss any concerns before your appointment. PLEASE CHECK ANY OF THE FOLLOWING THAT MAY APPLY TO YOU:

  • Types of medical conditions that may contribute to hair and eyelash loss: hyperthyroidism or hypothyroidism, alopecia areata, lupus, diabetes

  • Medications that may contribute to hair or eyelash loss: chemotherapeutic agents used in cancer treatment, Anticoagulants (blood thinners), beta blockers (used to control blood pressure)

  • My Policies

    I have certain policies in place to protect time that is set aside especially for you and to make sure you are receiving my full undivided attention with the best work possible.
  • Please read and sign below:

  • 𝐀𝐑𝐑𝐈𝐕𝐀𝐋𝐒:

    Please arrive to your appointment on time with clean/makeup- free eyes and lashes. If you arrive late, it may not be possible to extend the time available for your booked service; if your service is shortened due to your late arrival, you will still be charged the full cost of the service. In some cases the appointment may have to be rescheduled.


    𝐋𝐀𝐓𝐄 𝐀𝐑𝐑𝐈𝐕𝐀𝐋𝐒
    Please notify me promptly if you are running late.
    There is a 15 minute grace period from the start time of your appointment time. Arriving after the 15 minute grace period will accrue a late fee however, I will utilize the remaining amount of time to do as much as I can.
    Later than 30 mins will need to be rescheduled and result in a 50% late cancellation fee.


    𝐂𝐀𝐍𝐂𝐄𝐋𝐋𝐀𝐓𝐈𝐎𝐍 + 𝐍𝐎 𝐒𝐇𝐎𝐖
    Appointments will be charged 50% of the service fee if cancelled within 24 hours of your appointment. No call no shows will be charged 75% of the service. If your card on file is invalid or declines, in the event of a cancel or no show, you will be banned from my booking site and the balance will hold on your account.

    𝐅𝐈𝐋𝐋𝐒
    Please schedule your fills accordingly.
    Fill-ins are 40% remaining lash extensions. If you arrive with less than 40% this will require more time and product, an up charge will be implemented.
    Less than 30% or over 3 weeks will be charged as a full set.
    If you can count how many lash extensions you have on, it is a full set!
    *Following proper aftercare instructions will maintain good retention and extend the life of your lashes. If you suspect your fill appointment may need to be switched to a full set, please edit your appointment online or contact me to make sure we have enough time slotted for your appointment.


    𝐍𝐎 𝐑𝐄𝐅𝐔𝐍𝐃 𝐏𝐎𝐋𝐈𝐂𝐘
    There is a no refund policy on all services as you are paying for the artists time, skills, and products used.
    It is normal for your lashes to shed 2-5 lashes every day however, if you’re having excessive retention issues or other concerns following your service; I offer a 72 hour grace period to come in for a touch up at no extra cost.
    While there is no way to predict an allergic reaction, it is important to understand that anyone can have a reaction to the medical grade adhesive used for eyelash extensions.
    In the event of an allergic reaction, please contact me within 24 hours of noticing symptoms.
    Symptoms include: swelling, itching, and/ or redness around the eye area.
    While I am not allowed to give medical advice concerning reactions, I recommend having the lashes removed ASAP to prevent further discomfort.
    Removals will be done free of charge.
    *If you’ve experienced allergic reactions to extensions in the past and think you may have an allergy to the products, please let me know before your appointment as a patch test can be performed with a free consult!

    Aftercare policy: 

    Do not get lashes wet for the first 24 hours to ensure the glue cures fully.

    Do not use oil based products, creams or mascara of any kind.

    Use only water-based makeup and makeup remover. Remove makeup around the eye with a cotton swab.

    Do not perm, tint, or use eyelash curlers.

    Do not pull or pick at the extensions.

    Please contact me to have them removed if needed.

    To extend the life of your lashes, be sure to schedule an infill appointment every 2-3 week.

  • CLIENT WAIVER & RELEASE

    Please read each statement and acknowledge by checking each box by doing so you have READ, UNDERSTOOD and AGREE to the TERMS.
  • I understand there are risks associated with having artifical eyelashes applied to and/or removed from my existing eyelashes, and that not withstanding the utmost of care in the application or removal of these products, there still risks associated with the procedure and product itself, which include, without limiation, eye irritation, eye pain, discomfort, and in rare cases, blindness even when applied in the usual manner.

  • As part of the removal procedure, I understand that a certain amount of chemical adhesive remover is applied to exsiting adhesives and a reaction occurs to dissolve the adhesive that results in thinning of the remover. Even though the eyelash extension artist may apply or remove my eyelash extensions in the usual manner, I understand the liquid remover may seep into my eyes, which may irritate my eyes or require further follow up care, at my own expense to prevent damage to my eyes.

  • The agreement will remain in effect for this procedure and all future follow ups conducted by the certified eyelash extension professional. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement and hereby release any and all persons representing this salon from all claims, demands, damages, actions and cause of action arising out of ther performance of the service. I have fully disclosed all condtions regarding my health history, medications and past reactions to products, treatments and medications. I am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.

  • Parent/Guardian Consent Form

    Please complete this page if checked No to being 18+ years old.
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  • As the parent or guardian of        , I give permission for her to have Eyelash Extension Services performed.

    I confirm that I have read and understand all information provided to me on the treatment and risks. I         accept responsibility on my child’s behalf for any disclosures or liability described on this form.

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