Lash Extension Booking Form:
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like a PATCH TEST at least 48 hrs before your appointment to ensure no allergy reaction?
*
YES
NO
What service are you receiving today?
Lash Extensions
Lash Lift
Check all that apply to you:
I am pregnant or just had a baby in the past 4 months
I am taking Thyroid medication
I am currently on Chemotherapy
I am taking hair growth vitamins or collagen
I am using Saline eye drops
I currently have seasonal allergies that makes my eyes itchy / swollen
I am allergic to:
Latex
Metals
Adhesives
Surgical tape
Cyanoacrylate
Alcohol
Synthetic Fibers
Antihistamines
Other
Back
Next
Save
LASH EXTENSION CONSENT FORM
How did you hear about HCBeauuty? List name of person or site:
*
This procedure requires the certified lash technician to glue faux mink lashes to my natural eyelashes.
*
I UNDERSTAND
I DON’T UNDERSTAND
It is my responsibility to keep my eyes closed, be still, and not use my phone during the entire procedure which may take up to 3 hours.
*
I UNDERSTAND
I DON’T UNDERSTAND
Every attempt will be made to provide me with the look I desire, but my lash technician will place the length & diameter that are safe and won’t be damaging to my natural lashes and my final result may not be what I initially envisioned.
*
I UNDERSTAND
I DON’T UNDERSTAND
I should not pull off my lash extensions as it may result it permanent damage to my natural lashes & if I need my lash extensions removed I will consult with my lash tech for a professional removal.
*
I UNDERSTAND
I DON’T UNDERSTAND
I am required to follow the lash extension aftercare instructions in order to maintain the life of these extensions.
*
I UNDERSTAND
I DON’T UNDERSTAND
I have a 3 day courtesy refill if I have followed all instructions given and more than 40% of my lashes have fallen off, if more than 3 days pass there will be a fee for a fill.
*
I UNDERSTAND
I DON’T UNDERSTAND
My lashes have a natural shed & growth cycle, to maintain a full set I must schedule a fill appointment when I have lost 50% of my lashes. Should take 2-3 weeks, sometimes sooner.
*
I UNDERSTAND
I DON’T UNDERSTAND
I consent to before and after photos for the purpose of documentation, potential marketing and advertising purposes.
*
I AGREE
I DISAGREE
Cancelation Policy: if you’re late without communication your appointment is canceled. Cancellations must be made at least 24 hours in advance in order to use your deposit towards your rescheduled visit.
*
I UNDERSTAND
I DON’T UNDERSTAND
There are some risks of this procedure may be but not limited to eye redness, itching, swelling, stinging, burning, blurry vision, and potential blindness should the adhesive enter the eye or touch the skin, or an allergic reaction can occur.
*
I UNDERSTAND
I DON’T UNDERSTAND
My Lash Tech will take every precaution to minimize or eliminate negative reactions. I agree that by reading, & signing this form, I release Hannah Boyd from any liabilities, claims or damage of any nature that may result from this treatment & all future appointments or for any conditions that were present, but not disclosed at the time of this procedure that may affect this treatment.
*
I AGREE
I DISAGREE
ALL DEPOSITS, SERVICES, & PRODUCTS ARE NON REFUNDABLE.
*
I UNDERSTAND
I DON’T UNDERSTAND
By signing below I fully understand all statements above, I have had sufficient opportunity for discussion to have any questions answered.
Signature
Date
*
-
Month
-
Day
Year
Date
Save
Submit
Should be Empty: