Consent and Waiver of Liability

Eyelash Extension Consent & Waiver of Liability
Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.
Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Have you ever had eyelash extensions before?
If yes, what type and was there any discomfort during or after the procedure?
Have you had any allergies or an allergic reaction?
If yes, please clarify...
Do you have or had any of the following ?
Please add anything else you may seem appropriate that could effect having eyelash extensions.
CLIENT WAIVER & RELEASE

Please read each statement and acknowledge by checking each box by doing so you have READ, UNDERSTOOD and AGREE to the TERMS.
Please read each statement and acknowledge by checking each box:

I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed.I understand that lash extension services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging and burning, blurry vision and potential blindness should the adhesive enter the eye or should an allergic reaction occur. In the event of an reaction, we recommend seeking medical attention first and foremost. If desired or recommended by a medical professional, a complimentary removal will be provided however per the refund policy once the service has been completed, no refunds will be issued.I have been informed as to the methods and procedures regarding Semi-permanent Eyelash Extensions and/or Eyelash lifting. I am fully aware that there are no guarantees, either implied or expressed. I consent to this treatment as is. Per California State Board Regulation 7319 E I do understand that Lash Specialist Jazmin Ochoa, has been professionally trained by a licensed professionals on Semi-permanent and Eyelash Lifting , therefore I am aware if Lash Specialist Jazmin Ochoa, does not have an Esthetician or Cosmetology License. The Lash Specialist will provide the Semi-permanent Eyelash Extensions and/or Eyelash Lifting procedure as a Product of Retail, demonstrating the procedure on the customer who purchases the product. I hereby certify that I fully understand and comply with all aspects of the above reference disclose by Lash Specialist Jazmin OchoaI understand there are risks associated with having artifical eyelashes applied to and/or removed from my existing eyelashes, and that not withstanding the utmost of care in the application or removal of these products, there still risks associated with the procedure and product itself, which include, without limiation, eye irritation, eye pain, discomfort, and in rare cases, blindness even when applied in the usual manner.As part of the removal procedure, I understand that a certain amount of chemical adhesive remover is applied to exsiting adhesives and a reaction occurs to dissolve the adhesive that results in thinning of the remover. Even though the eyelash extension artist may apply or remove my eyelash extensions in the usual manner, I understand the liquid remover may seep into my eyes, which may irritate my eyes or require further follow up care, at my own expense to prevent damage to my eyes.
The agreement will remain in effect for this procedure and all future follow ups conducted by the certified 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 and hereby release any and all persons representing this salon from all claims, demands, damages, actions and cause of action arising out of ther performance of the service. I have fully disclosed all condtions regarding my health history, medications and past reactions to products, treatments and medications. I am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.
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Eyelash Extension Consent & Waiver of Liability

CLIENT WAIVER & RELEASE