lash lift and tint

Lash Lift & Tint / Brow Lamination / Henna Brows / Brow Tint / Waxing Procedure Consent & Client Intake
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Name

First NameLast Name
Phone Number

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Email
example@example.com
I authorize Embe (Wynx) Studio and all of their associates to provide and apply the following service and or services: semi-permanent lift & tint/ lash relax and or brow lamination, brow tinting, brow henna, facial waxing. In order to minimize risk of injury, I understand that it is my responsibility to lie completely still for the entire procedure or until otherwise directed by the technician. I have been fully informed regarding the methods and procedures used in the application and aftercare recommendations. All risks and potential complications, including but not limited to, redness, irritation, and allergic reactions to either the adhesive, eye pads, chemicals, tape, tint, wax, aftercare or pretreatment products etc or any other products used have been fully disclosed to me. I certify that I understand these risks and potential complications, and that I knowingly and voluntarily consent to the application for the services listed above.

If at any time I feel uncomfortable during the procedure, I agree to immediately notify the the technician. The technician will see to remedy the problem, including ending the session if it is deemed prudent by the technician. I acknowledge that there are no guarantees or promises regarding the appearance or longevity of any of the above servives . I herby certify that I have disclosed all conditions regarding my health history, and past reactions to products, treatments and medication I am currently or recently using.
I understand and consent to having my eyes closed and covered for the duration of up to 2+ hour procedure. Times may vary.*

Yes
I understand that in rare occasions there are risks associated with having any service provided. I further understand that in rare cases as part of the procedure eye/ brow/ skin irritation and discomfort could occur. I agree that if I experience any of these conditions that I will contact Melyssa at Embe (Wynx) Studio.*

Yes
I acknowledge that the natural lash cycle is sixty to ninety days. When one lash falls out, there is another lash growing in. I, therefore, understand that I will need regular lift and tint appointments to keep my lashes looking beautifully lifted and have a natural curl. Lash lift and tints typically will grow out before lashes lose their curl or tint fades. Brow lamination treatments are similar. Embe (Wynx) lash lift and tints and brow laminations are recommended every 5-8 weeks. Henna brows and brow dye (Hybrid) will stain the skin for average 5-10 days and stain the brow hairs for up to 6 weeks. The ability to stain the skin is dependent on skin type. The longevity will depend of natural skin cell turnover, skin type, and aftercare. I understand that variables, including the natural lash and brow cycle and homecare, will influence the longevity of the service provided.*

Yes
Do you experience allergies?

YesNo
If yes, please explain:
Do you have oily skin, combination or dry skin?

OilyComboDry
If yes, please explain:
I agree to avoid steam from showers, saunas, dishwashers and swimming pools, tanning beds, makeup and touching of the treated area for 24 hours following the appointment.*

YesNo
I agree to avoid getting the treatment area wet and avoiding the application of any product to the treated area for the first 24 hours*

YesNo
I agree to avoid spray tanning for at least 24 hours before and after treatment.*

YesNo
I understand that the lashes and laminated brows are porous and malleable for the first 24 hours after treatment.*

YesNo
I understand that keeping my lashes and brows hydrated is beneficial. Embe (Wynx) Studio will give recommendations on aftercare serums if recommended.*

Yes
I agree to inform all service providers regarding my treatment when going for facial work. I understand that caution is recommended when having services such as lasers, chemical peels, hydroxyl treatments, or any other acidic substances applied.*

YesNo
I understand that touching my lash and brow area with my fingers has the potential to introduce germs, oil, and bacteria and can result in breakage of lashes, and infection. Avoiding touching of the eye and brow area post treatment is recommended.*

YesNo
I agree to avoid the use of eyelash curlers (heated and non heated) and chemicals such as DIY lash and brow treatments as these can cause lash breakage and possible chemical reactions.*

YesNo
I understand that Embe (Wynx) Studio is a conservative artist. Processing times, lengths and weights for lashes and brows will be used or applied at technicians disrecetion. The natural health and integrity of natural lashes and brows will be taken into consideration will all services.*

YesNo
Please check all that apply and are relevant. I am informing my technician of the following:*

Current use of contact lensesCurrent use of eye drops of any kind, prescription or over-the-counterCurrent use of oil based products such as sunscreen, moisturizer, face wash and make-upHistory of recurrent eye or tear duct infectionsHistory of dry eyesReceived chemotherapy in the last 6 monthsDiagnosed with an overactive/ underactive thyroidCurrently taking Thyroid medicationPregnant or breastfeedingTaking supplements or medications that may affect hormonesTaking birth controlAllergies- seasonal, environmental or otherHistory of hay feverHistory of styes or other types of eye infectionsPrevious reaction to lash extensions/ last lift and tints/henna/ waxing/ brow laminationsCurrent use of acne medications or within the last 6-12 monthsCurrent or recent use of Retinol, Vitamin A, AHA/BHA/Glycolic peels/ lasering
If you checked any of the previous boxes- please elaborate here:
I understand that there are contraindications to all services. Common contraindications are but not limited to: Psoriasis/ Eczema, recent surgery to the area, permanent make up within 6 weeks, sunburn or dun damage to the treatment are, sensitive skin, acne medications- topical or taken orally (eg. Accutane) within the last 12 months, medications that affect hormones, blood thinners, current or recent use of Vitamin A, topical Rentin-A, pharmaceutical or high grade Retinol, Retrieve or other prescription skin medications (within the last 4 weeks), AHA/BHA/Glycolic peels or have had laser resurfacing or skin needling (within the last 4 weeks). Those who have previously had a reaction to any form or tint, brow lamination/ lash lift or wax/ henna procedure in the past- or any sign of infection, cuts, or scabbing or swelling. Those who have had laser eye surgery or an eye infection in the last 3 months. Pregnancy and breastfeeding. If you are concerned about a contraindication please let Melyssa (Embe (Wynx) Studio) know. Alternative treatments may be available.*

Yes
I allow permission for photos to be used on social media, for advertising and or training purposes.

YesNo
I understand there are no refunds or partial refunds offered for services provided.*

Yes
I understand that payment is required in full at the end of the service provided. Acceptable methods of payment are Cash, Debit & Credit.*

Yes
I understand that cancellations must be made with minimum 24 hour notice. If you have not arrived for your appointment and are 15 minutes late, your appointment is then considered a No Show Cancellation. Late cancellation/ No show will be responsible to pay 100% of the service fee. Please be mindful when needing to cancel or reschedule and let me know as soon as possible so Embe (Wynx) Studio is able to accommodate clients on the waitlist. Clients who reschedule within 24 hours of appointment will be required to pay a $20 rescheduling fee. Clients with 2 consecutive reschedules will be required to pay a deposit to book their appointments.*

I accept the Cancellation policy described here
I understand that Embe (Wynx) recommends no mascara or strip lashes for at least one day prior to lash and appointments and no spray tanning 24 hours prior to brow appointments. Even when washed, mascara, mascara residue, strip lash glue and strip lash glue residue can leave a film on your natural lashes and affect the results of the service. Chemical reactions between products can occur with spray tanning products and lash lift and tint and brow henna and brow lamination treatments.*

I understand.
BY COMPLETING THIS CUSTOMER WAIVER AND LIABILITY AGREEMENT, I THE CLIENT NAMED HERE CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE EMBE (WYNX) STUDIO AND ITS DIRECTORS, OFFICERS, OWNERS, EMPLOYEES, AGENTS AND REPRESENTATIVES FROM ANY AND ALL CLAIMS FOR DAMAGES OR PERSONAL INJURY ARISING FROM THE APPLICAION AND USE OF SEMI-PERMANENT EYELASH EXTENSIONS OR ANY OF THE OTHER ABOVE MENTIONED SERVICES AND PROCEDURES, INCLUDING ANY DAMAGES RELATING TO KNOWN OR UNKNOWN COMPLICATIONS WHICH MAY ARISE DURING OR FOLLOWING THE APPLICATION PROCESS INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE. I FURTHER RELEASE AND HOLD EMBE (WYNX) STUDIO FROM ANY CLAIMS RELATING TO PRE-EXISTING CONDIIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE.*

Yes
I AGREE THAT ANY DISPUTES BETWEEN EMBE (WYNX) STUDIO SHALL BE SETTLED BY ARBITRATION ADMINISTERED BY THE ARBITRATION ASSOSIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES, AND JUDGEMENT ON THE AWARDED RENDERED BY THE ARBITRATOR(S) MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF THE PREVAILING. PARTYS SHALL BE ENTITLED TO REASONABLE ATTORNEY FEES AND ABRITRATION COSTS INCURRED IN CONNECTION WITH ENFORCING THIS AGREEMENT.*

Yes
I certify that I have read and fully understand this Customer Waiver and Release Agreement. I further certify that I have completed the Client Confidential Profile accurately and completely to the best of my knowledge, and that I understand the complications and risks described herein. I herby authorize Embe (Wynx) Studio and associates to provide any of the above mentioned services or products, in accordance with the terms and conditions set forth in this agreement.
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Lash Lift & Tint / Brow Lamination / Henna Brows / Brow Tint / Waxing Procedure Consent & Client Intake