Dolled By Daysi Eyelash Extension Consent Agremment

Full Name

Name Last name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Age

Cell Phone Number

Area CodePhone Number

Email

example@example.com

Are you under the influence of alcohol or drugs

Is this your first time having Eyelash Extensions?

Are you having lash extensions applied for?

Do you wear contact lenses? If so, contact lenses MUST be removed prior to eyelash extensions procedures. Products may get underneath the contact lens and cause an abrasion or scratching.

Do you have ANY make-up around your eyes today?

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

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

Please list any eye drops or eye medication you are currently using

Are you able to lay on your back for 1-2 hours to have your lashes applied?

Will you be able to keep your eyes completely closed for up to 2 hours?

Are you pregnant?

What other products do you currently use around your eyes? ( eye creams, oinments, lash serum, etc.

Please note that Dolled By Daysi do not recommend the use of mascara or any oil based products at least 48 hours BEFORE to your lash appointment. Dolled By Daysi recommends to avoid the above products AFTER your lash extensions as those products will loosen the adhesive and your lashes will not last long.

Please initial and date you read and understand the above.

Do you use lash serum such as Lattice or over the counter ones? It is best to discontinue the use of these at least 2 weeks before you appointment and discontinue the use while you are wearing your lash extensions. Some contain oils and/or steriods and will shorten the duration of your extensions.

How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.

Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.?

Have you had Chemotherapy Treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.

Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products Dolled By Daysi uses for prepping the eye area (gel pads, glues, etc.)

Have you had any prior eye condition, (like Blephoroplasty) or any eye surgery in the last 6 months? Any conditions that might be sensitivity to eyelash extensions and products used. If you have a condition you should consult with your doctor first.

Company Privacy Policy

We value your privacy. We do not disclose your personal information or share it with other outside entities unless otherwise authorized by you. Your information is used for internal statistic, marketing, or educational purposes. We do not send spam emails. We only communicate with our clients and potential clients regarding new services, price changes, special offers, and appointment notifications.

Attendance Policy

Our time is very valuable. To ensure that I can provide all of our clients with excellent service, Dolled By Daysi ask that you be on time for all of your appointments. Please arrive at least 5 to 10 minutes prior to your scheduled time to ensure you receive your full appointment time. Clients who arrived 15 minutes after their appointment time will be rescheduled. A 48-hour notice is required for any canceled or rescheduled appointment or 100% of service (s) price will be charged (NO EXCEPTION). Dolled By Daysi does not offer refunds on service (s) rendered. We do have a 7- day policy in place on services in which a client can come back and have corrections made. By initialing here, I’m acknowledging I have read and understood the terms of these policies.

What to expect on your appointment.

Step 1 - Consultation with your Lash Extension Expert to insure this service is right for you and to explain your before, during and after experience thoroughly.

Step 2 - Select the style of lashes you would like, to cover length, fullness and shape. If you're unsure, your lash tech will be happy to recommend what's best for you and your lifestyle.

Step 3 - Get Lashed Up!

Step 4 - Rebook for your refill in approx 2 1/2 to 4 week.Just a few more things! This is to insure a great service and outcome for you.

I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 /12 to 4 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.

Initial

I will seek medical care (at my own expense) and contact Dolled By Daysi immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.

Initial

I agree and understand that Dolled By Daysi has no way of knowing if the client is allergic to some of the products or materials been use in any procedure.

Initial

I give Dolled By Daysi permission to use my before and after photos for marketing or examples of the work performed.

I release Dolled By Daysi from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that Dolled By Daysi has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme tempatures, natural eyelash shedding and other factors. Dolled By Daysi along with my consent form and consultation will decide if I am a good candidate for this service to the best of our ability.

Initial

By signing below, I verify that I have read and understand the above statements and agree to them.

By signing below, I verify that I have read and understood the above statements and agree to them. It also gives consent to my electronic signature in lieu of an original signature.

Sign Date

Date

Dolled By Daysi

The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below for each condition.