Lashed by Ana Consent and Policies Form

Consent Form

Thank you for choosing Lashed by Ana

(PLEASE DO NOT FILL FORM MORE THAN TWICE, ONE FORM IS ENOUGH)
I   First Name*   Last Name*    agree to have eyelash extensions applied to or removed from my natural eyelashes. By signing this, I give consent for the licensed professional to apply, remove, or retouch the eyelash extensions.
Phone Number:        Phone Number*
Email:   Email*
Today's date:   Date*
I am over 18 and consent to this agreement and the eyelash extension procedure. AGREE DENY*
* If you are under the age of 18, please have a parent/guardian complete
this form including formed attached: https://form.jotform.com/220324083724044
Have you ever had eyelash extensions before?   YES   NO*

If not, would you like to have a patch test, which we strongly recommend? Please note that a patch test does not guarantee you won't have a reaction. It must be done within 48 hours before your appointment.
YES   NO*

If you choose not to have a patch test, you agree to take full responsibility for any reactions. Even with a patch test, a reaction may still occur. By signing, you confirm that you understand this and agree to the treatment, whether or not you have a patch test.    AGREE*
Health History | Please check any of the following that applies to you

Allergy to adhesives band aid or medical tapeAllergy to surgical glue or nail glueAllergy to any type of mascarasSeasonal allergiesPregnancyBack injury or severe painEye illness or injuryBlepharitis (inflamed eyelids)Glasses or contactsDrugs that can cause temporary hair lossMajor surgery within last 120 daysOther
Do you have any eye sensitivity that you are aware of or have reacted slightly to in the past? Extra measures can be made during your treatment to make it more comfortable.
Please agree to the terms and conditions*

I agree to have eyelash extensions applied, removed, or retouched on my natural eyelashes. By signing, I consent to the application and/or removal of the extensions by a licensed professional.I understand and agree to follow the after-care instructions given by the certified eyelash extension professional, including: no mascara, no oil-based products near the eyes, no water on the extensions for 24 hours after application, no tinting or perming of the extensions, and no pulling or rubbing of the lashes. I accept that not following these instructions may cause the extensions to fall out or shorten their lifespan.I understand and consent to having my eyes closed and covered for the 40-180 minute procedure, with the time varying depending on the type and number of lashes applied.I understand that there are rare risks associated with artificial eyelashes, including the possibility of eye or skin irritation and discomfort.I understand that due to the natural lash cycle and wear, touch-up appointments are usually recommended every 2 to 3 weeks to keep my extensions looking full.I understand that if I have any issues or am unsatisfied with my results, I must notify within 48 hours for a correction. After 48 hours, any fix will be treated as a fill.I understand that services and gratuity are non-refundable, including security deposits.
Agree*

YesNo
FOREIGN FILLS

Please ignore if it does not apply to you
I, First Name Last Name , understand that a foreign fill will only add new lash extensions to my current set. I am aware that the lash tech will decide whether to approve or deny the service based on the condition of my lashes from the previous artist. I do not hold Ana Reveles responsible for the condition of my lashes. I take full responsibility for my lash extensions. If my lashes do not meet her standards, I will need to book a removal and a new set. I agree to have my photo taken to determine if I am eligible for a foreign fill.
Foreign Fills:Foreign fills are now accepted, but the set must still meet my fill policy. I can only work over the existing lashes if they are not damaged by the previous artist. If the set is unworkable, I will not continue the fill, and you may need to book a removal and new set. This service is for clients with lashes applied by another artist. I must approve the service before booking, so please provide a clear photo of both eyes, showing the lash line.
I agree to the foreign fill policy and take full responsibility for the outcome, I do not hold Ana Reveles liable for the previous work I had before coming to her.

I agree
Cancellation policy:

Your appointments are very important to us at Lashed by Ana. To ensure quality service, we ask for at least 24 business hours’ notice for cancellations. Late cancellations (less than 24 hours’ notice) will incur a fee of 50% of the service cost. For same-day bookings, cancellations must be made at least 4 hours before the appointment to avoid this charge.

No-shows will be charged 70% of the service cost and must settle the balance before rebooking. Arrivals more than 10 minutes late may result in rescheduling and will be treated as a no-show, with the full service amount charged.

A valid credit or debit card is required to secure your appointment. This policy helps us provide the best experience for all clients. Thank you for understanding!
Agree to the cancellation policy:*

YesNo (Appointment will be denied)
Agree to the no show policy: you are agreeing to the statement above and give us full access to charge the card on file WHEN you no show to your scheduled appointment.*

YesNo (Appointment will be denied)
Do you agree to have pictures/video taken during or after this treatment and allow them to be shared on social media:*

YesNo
COVID-19

Due to the 2019-2020 outbreak of Coronavirus, COVID-19, we are taking extra
precautions with the intake of each client, health history review, as well as sanitation and
disinfecting practices. Please complete the following and sign below.

I, First Name* Last Name* , confirm that I am not presenting any of the
following symptoms of COVID-19 listed below: fever, shortness of breath, loss of taste or smell, dry cough, runny nose, sore throat.

I agree to the following:
● I understand the above symptoms and affirm that I, as well as household members, do
not currently have, nor have experienced the symptoms listed above within the 14 days.
● I affirm that I, as well as household members, have not been diagnosed with COVID-19 within the last 20 days.
● I understand the COVID-19 virus has a long incubation period during which carriers of
the virus may not show symptoms & still be highly contagious.
● I understand that due to the frequency of visits of other clients, the characteristics of the
virus, and the characteristics of these services that I have an elevated risk of contracting
the virus simply by being in the establishment.
● To prevent the spread of the contagious virus and to help protect each other, I
understand that I must follow the establishment’s guidelines.

○ Reschedule appointment if you are feeling unwell
○ NO ADDITIONAL GUESTS ALLOWED
○ Wearing a mask is required upon arrival and during the entire service
○ Wash hands upon arrival

I, Signature knowingly and willingly consent to have eyelash extension service during the pandemic and will not hold Lashed by Ana or anyone working for this establishment, liable for the possibility of contacting COVID-19.
Date

MonthDayYear
Date
Client Signature*
This agreement will remain in effect for this procedure and all future follow-ups conducted by the licensed 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.
Should be Empty:

FOREIGN FILLS