Eyelash Extension Consent Form
Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
I release Lionheart Lashes 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 the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.
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Initial
I am informing the certified eyelash extension professional of any of the following conditions:
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Current use of contact lenses, which I may be asked to remove during the service
Current use of anything such as oil-containing sunscreen/moisturizers around the eyes
Current use of eye drops of any kind
Current allergies or sensitivities (adhesives, tapes, glues, band aids, etc)
Current use of lash serum (Lattice, Grandelash, etc)
History of recurrent eye or tear duct infections
Recent history of Chemotherapy
Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions (such as surgery, lasik, thyroid, etc.)
Any condition that would prohibited you from laying on your back for an extended period of time (anywhere from 1-3 hours)
None of the above
I agree and understand that Lionheart Lashes and my technician have no way of knowing if the client is allergic to some of the products or materials being used in any eyelash procedure. Lionheart Lashes does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
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Initial
I understand and agree to the aftercare instructions provided by Lionheart Lashes for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the extensions to fall out and/or decrease the time the lashes will last. In my failure to adhere to these instructions, I may be subject to a lash cleaning before my appointment which will be an additional charge and will decrease the time of my appointment.
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Initial
I agree to the following eyelash extension after care and maintenance instructions: (Check to agree)
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No mascara
No oil-based products around the eye area
No water can come in contact with the eye area for 24 hours after the application
Lashes will be cleaned daily (or every other day for non-oily, non-makeup wearing clients) with lash extension safe soap and dried properly with soft, lint free cloth or hair dryer on low/cool setting
No tinting, perming or curling of the eyelash extensions
No pulling, rubbing or picking of the eyelash extensions
Should any eye drops be necessary, extra care should be taken to prevent moisture from coming into contact with the extensions
Lashes will be clean and free of makeup/dirt on the day of my appointment
Eyelash extensions require on-going maintenance (similar to a nail service). Fills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time or have less than 50% lashes remaining it may result to a service cost as a full-set.
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Initial
C
ANCELLATION/NO-SHOW POLICY
I acknowledge Lionheart Lashes does their full effort to fulfill my appointment times and I respectfully acknowledge the times I schedule to be available. I understand the following set cancellation policies that are also non-refundable agreements of service. If you cancel or reschedule less than 24 hrs before your appointment, a 50% service fee will be accessed upon cancellation. If you no-show to your appointment, a 50% service fee will be charged. If you cancel/no-show often you will be no longer able to book with Lionheart Lashes. While things may happen, we advise appropriately booking.
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Initial
REFUNDS
I acknowledge and understand that the salon doesn’t offer refunds. Lionheart Lashes will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes after every appointment. In the unlikely event that you are unsatisfied with your lashes or an abnormal amount have fallen out, please contact Lionheart Lashes within 72 hours of appointment and a complimentary fill will be given.
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Initial
PHOTO/VIDEO RELEASE
I grant permission to Lionheart Lashes to use my before and after photos/videos for marketing or examples of my technicians work.
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Initial
Thank you for giving me the time to get to know you & signing the consent form.
By signing below, I verify that I have read and understand the above statements and agree to have answered all questions to the best of my knowledge. This agreement will remain in effect for this procedure and all future follow-up appointments conducted by Lionheart Lashes.
Date
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Month
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Day
Year
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Signature
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I'm Ready!
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