Consent Form
EYELASH EXTENSIONS
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you or anyone you have been in contact with been exposed to ANY sickness? Including, covid-19, flu, fever, cold, cough
Yes
No
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I give the lash artist my permission to display pictures of myself on social media without claim.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
I agree that I will not hold Always Couture LLC responsible for any unforeseen condition arising out of the indicated procedure. .
I understand a non-refundable deposit is required to book. If I cancel my appointment within 48 hours of the appointment the deposit is forfeited.
I understand if I no-show my appointment I will be charged 100% of the service with the card I left on file with the lash artist.
I agree to allow the lash artist to charge the card I leave on file for any fees/expenses that are owed without any notification because I am already aware of the policies.
I understand there are NO REFUNDS
I understand if I am more than 10 min late, I will be charged a late fee. I understand if I am more than 15 min late my appointment will be canceled, my deposit will be forfeited, and I will have to make a new appointment.
I understand Always Couture LLC can refuse the right to provide service at anytime.
I have read and I am aware of Always Couture LLC policies and I accept and understand them.
Date
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Month
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Day
Year
Date
Client Signature
Submit
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