Client Release & Consent Form - For Eyelash & Eyebrow Services
Hannah Davis Lashes
First & Last Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Date of birth
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-
Month
-
Day
Year
Date
What service(s) are you having done? (Check all that apply) If you are having a Consultation — please select the service you are wanting to have done in the future.
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Eyelash Extensions
Eyelash Lift & Tint
Eyelash Lift
Eyebrow Lamination
Eyebrow Tint
Do you wear glasses or contact lenses?
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Glasses
Contacts
Both
None
Are you currently Pregnant or Breastfeeding?
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Pregnant
Breastfeeding
Neither
Do you have any skin issues or sensitivities? (i.e. eczema, sensitive skin, psoriasis, skin trauma or, previous allergic reactions to beauty services that are relevant)
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Yes
No
If you checked "Yes" to the skin issues or sensitivities question please explain your issue.
Are you currently taking Accutane or any other medications that may affect the sensitivity levels of your skin?
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Yes
No
Are you currently suffering from any eye/skin infections such as pink eye, stye(s), or anything contagious?
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Yes
No
Please list any relevant allergies we should know about.
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Have you ever had the service(s) done before that you selected previously on this form?
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Yes
No
Yes & No (If you selected more than one service and you have had one done before but not the other.)
If you selected “Yes” or “Yes & No” on the question above, have you ever had a past allergic reaction to the service(s) or experienced any kind of irritations upon having the service(s) done that raised some personal concerns?
Yes
No
If you selected “Yes” on the question above, please further explain below.
What is the current date you are filling out this form?
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-
Month
-
Day
Year
Date
After Care: By checking “Yes, I will”, you understand and agree to follow all after-care instructions provided by Hannah Davis Lashes. You understand and accept that if you fail to follow the after-care instructions that is your choice and Hannah Davis Lashes is not responsible for whatever happens after you leave your appointment if you fail to follow the after-care.
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Yes, I will.
Agreement: By checking "Yes, I Agree" to this form I consent and request that the procedures which I have requested be carried out today and for any appointments in the future without a sensitivity patch test. The sensitivity test, which if conducted may indicate any allergies/sensitivity to the materials. I understand these terms and take full responsibility for all my actions during the duration of my appointment and future appointments. Thus, absolving all other parties of their responsibility to any allergic reactions or anything else sustained during your appointment time. As well, by checking "Yes, I Agree" below I release Hannah Davis Lashes from all liability, costs, and damages that could arise in the time spent at my appointment today and future appointments. This agreement releases Hannah Davis Lashes from any liability for any injuries that may occur at the place and time of appointment from here on out, meaning any future appointments made. Lastly, by checking "Yes, I Agree" I confirm all the information I provided when I booked, on this form, and on any other forms is completely truthful and credible. I agree to hold Hannah Davis Lashes entirely free of liability towards any incidents regardless if it is caused by negligence or not.
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Yes, I agree.
Please sign here (Parent or Guardian signature required if under 18 years of age)
Please sign here (Individual having service(s) done)
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Submit
Should be Empty: