LVSHD consent form

date*

MonthDayYear
full name*
email*
example@example.com
phone number*
lash extensionsbrowslash liftdermaplaningnone for now
yesno
yesno
have you had any recent eye infections? if so, please specify
are you currently taking any medications (including any non-prescription)? *
do you have any sensitivities or allergies? please specify*
are you using retinol?
severe sunburnconjunctivitisthyroid diseaseblepharitisstyesdry eyessensitive eyeseyelid dermatitisalopecia areatapsoriasissigns and symptoms of sickness i.e influenza, coronavirusnone of the aboveOther
I (name)* agree to have my eyelash extensions applied to my natural eyelashes and/or removed by a certified eyelash extension professional.

I (name)* agree to have my brows/lashes/skin treated by a professional beauty therapist

I (name)* completely understand and accept the potential risks associated with lash and brow services and consent to the service.
i acknowledge the contagious nature of coronavirus (COVID19) and the public health orders in place to practice social distancing to further prevent exposure. i further acknowledge that lashesbypaige has put in preventative measures to reduce the spread of COVID19. i conform that; *i am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking, muscle pain, headache, sore throat, loss of taste or smell. *i have not travelled to a highly impacted area within the last 14 days. *i do not believe i have been exposed to someone with a suspected and/or confirmed cased of coronavirus. *i am following all orders in place in regards to coronavirus.
signature*
Should be Empty:

I (name)* agree to have my eyelash extensions applied to my natural eyelashes and/or removed by a certified eyelash extension professional.

I (name)* completely understand and accept the potential risks associated with lash and brow services and consent to the service.