Eyelashes Extensions Consent Form

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Full Name

First name Last name

Cell Phone Number

Format: (000) 000-0000.

Email

example@example.com

I grant permission to Cameron E Beauty to use my before and after photos for marketing or examples of my technicians work.

I release Cameron E Beauty 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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I acknowledge and understand that she doesn’t offer refunds. Cameron E Beauty will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.

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I acknowledge and understand that Cameron E Beauty will educate me on the proper lash extensions aftercare and products. And if I choose not to follow her instructions, my lashes may not last as long as advertised.

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I understand that lash extensions don’t last forever and Cameron E Beauty offers 72 hour touch ups ONLY if I have EXCESSIVE fallout.

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I understand that communicating to my eyelash professional is IMPORTANT if I have any complaints or concerns. (Fallout or allergic reactions)

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I acknowledge Cameron E Beauty does her full effort to fulfill my appointments 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 24 hrs before your appointment you be required to pay half of your next service appointment down as a deposit. Second cancellation offense, you will be required to pay the full amount for next lash extensions appointment. If you cancel often you will be no longer able to book with Cameron E Beauty. While things may happen, we advise appropriately booking.

Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set.

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Is this your first time having Eyelash Extensions?

Are you having lash extensions applied for?

If you do wear contacts, do you acknowledge that if you wear them to your appointment you are more prone to a chemical burn on your eyes?

Do you wear Contacts?

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

Do you have a severe eye illness or are you being treated for an eye injury?

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. 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 able to lay on your back for 2 - 3 hours to have your lashes applied?

Are you pregnant?

It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. Let's talk approved products during your appointment. Please come to your appointments with no eye-makeup.

Please initial you read and understand the above.

How would you describe you eyelids skin and around your eyes?

Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that 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 used for prepping the eye area. (gel pads, glues, etc.)

Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may not have lash extensions last long due to either of these

I agree and understand that Cameron E Beauty has no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. Cameron E Beauty 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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Blepharoplasty or other eye condition or surgery in the last 6 months? Blepharoplasty, eye surgery or conditions may have sensitivity to eye-lash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service

I acknowledge that if I run 10 minutes or more behind, my appointment will be cancelled

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I acknowledge that if I no-show or cancel within 24 hours notice that my card on file may be charged 25% of the service I had scheduled

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I acknowledge that if I have an issue with my lashes 72 hours or sooner, I am subject to come back for a free touch up. Any time after the first 72 hours will not be valid for a free touch up

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I acknowledge that if I have an allergic reaction that Cameron will no longer be able to service me for lash extensions. It is always recommended to seek a doctor for any medical advice regarding an allergic reaction. (If any of my products are changed, I always notify and seek consent from you as a client beforehand)

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I understand that before I schedule a full set I could get a free patch test if I wanted!

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I acknowledge that if I schedule a fill and I have less than 40% of my lashes left that it will be charged as a full set.

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Please read & agree to my following policies: ALL CARDS ARE CHARGED A 3% PROCESSING FEE PER TRANSACTION.•PLEASE DO NOT BRING ANY EXTRA GUESTS TO YOUR APPOINTMENT.• IF YOU NO- SHOW YOUR APPOINTMENT YOU WILL BE REQUIRED TO PAY 50% OF THE ORIGNAL SERVICE BOOKED UPFRONT IN ORDER FOR ME TO BE ABLE TO CONFIRM YOUR APPOINTMENt.•IF YOU ARE LATE AFTER 1O MINUTES OF YOUR ORIGINAL APPOINTMENT TIME. YOUR APPOINTMENT WILL BE Cancelled and YOU WILL HAVE TO RESCHEDULE.• INFILL PUNCH CARDS ARE AN INCENTIVE TO GET YOU TO COME BACKAND EARN a discount AFTER A CERTAIN AMOUNT OF VISITS. IF YOU LOSE/MISPLACE YOUR PUNCH CARD, YOU WILL HAVE TO START A NEW PUNCH CARD. THE OLD CARD WILL NOT BE HONORED •HOLDING APPOINTMENTS FOR THE SAME SERVICE DURING THE SAME WEEK IS NOT AN OPTION. PLEASE BE COURTEOUS AND CHOOSE ONE THAT BEST FITS YOUR SCHEDULE.•IT'S REQUIRED TO HAVE A CARD ON FILE FOR YOUR APPOINTMENT, FOR HOLDING YOUR SPOT AND ENSURING YOU'LL SHOW UP. OTHERWISE IF YOU NO SHOW OR CANCEL WITHIN 24 HOURS OF YOUR APPOINTMENT, A 50% CHARGE OF THE SERVICE YOU BOOKED WILL BE CHARGED TO YOUR CARD WHEN BOOKING.•BOOK ATIME THAT BEST WORKS FOR YOU. I WANT TO ENSURE YOU GET THE BEST SERVICE DONE POSSIBLE, WHEN YOU OR I AM RUSHED YOU DON'T GET THAT CHANCE TO EXPERIENCE THAT • A 2 DAY FREE TOUCH UP IS ALLOWED IF YOU'RE HAVING A PROBLEM WITH YOUR LASHES. CONTACT ME AND LET ME KNOW. AFTER THAT TIME PASSES. YOU ARE NO LONGER ELIGIBLE FOR A TOUCH UP.•PLEASE USE MY BOOKING APP'S LINK LOCATED IN MY BIO. IF YOU CANNOT FIND AN APPOINTMENT THAT BEST SUITS YOU YOU CAN USE THE WAITLIST TO SPECIFY WHEN YOURE LOOKING TO HAVE AN APPOINTMENT. ALL BOOKING IS STILL THROUGH ME!•YOU CAN SIT IN THE WAITING ROOM IN MED 1 AESTHETICS OR YOURE MORE THAN WELCOME TO TEXT ME FROM YOUR CAR BEFORE YOUR APPOINTMENT TO SEE IF IM READY FOR YOU OR NOT!

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Thank you giving us the time to get to know YOU & signing the Consent form, its much appreciated towards your lash experience!

Sign date

Date

Client signature

Eyelash Extensions Intake & Consent Form

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

The following are Cameron E Beauty’s Policies