Facial / Waxing / Tint / Lash + Brow Perm Services: Confidential Client Intake / consent / liability Form

I hereby Consent and authorize Alyssa Jones to perform the following procedure(s):

All Facial Services, Body services, Microdermabrasion, Chemical Peel, Waxing, lash and brow Tinting, lash lift (lash perm), brow lamination (brow perm) services.

I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment have been discussed.

I understand and acknowledge that there are risks involved with the treatment I will be receiving including, but not limited to:

Mild to moderate discomfort or pain

Slight redness or swelling Itching or irritation

Pigment changes, Scarring, Allergic reaction, Bacterial infection

Sun Sensitivity, Skin Sensitivity, Skin peeling or flaking up to 14 days after the procedure

I understand that waxing may have certain side effects which may include but are not limited to skin removal, redness, swelling, and tenderness. 

I fully understand and acknowledge that there are risks involved with the treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.

I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle, and that there is a possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost.

I have read and understand the post-treatment home care instructions. I also understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the esthetician immediately.

I have to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently taking or using topically.

I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. I agree I will assume the risk and full responsibility for any and all injuries, losses, side effects, or damages that might occur to me while I am undergoing this procedure. I do not hold the esthetician, Alyssa Jones  responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

This agreement will remain in effect for this procedure and all future follow-ups conducted by Alyssa Jones. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I am over 18 years of age (or have consent from my parents/legal guardian) and consent to the agreement and to the service I have selected. 

By signing below, I agree to the following: I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition (s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician Alyssa Jones and the salon Blushing Babes Beauty Bar or Simply You Salon for any injury or damages incurred due to any misrepresentation of my health.

By signing below, I agree to the following: I have completed this form to the best of my ability and knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform the technician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liability toward my technician Alyssa Jones and the salon Blushing Babes Beauty Bar or Simply You Salon for any injury or damages incurred due to any misrepresentation of my health.

Although every precaution will be taken to ensure my safety and wellbeing before, during and after my lash extension application, I am aware of the following information and possible risks:

I understand that lash extensions can make the appearance of my own lashes  thicker and appear longer.

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.

I understand that some irritation, itching, or burning may occur on the skin if the bonding agent comes into contact with it.

I understand that this is a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch-up or “fill” appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out.

I understand that while every attempt will be made to provide me with the length and fullness I have chosen, my final result may not be what I initially envisioned.

I understand that it is imperative that I disclose all of the information requested on the Client Intake Form.

I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.

I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure.

I consent to “before and after” photographs for the purpose of documentation, potential advertising, and promotional purposes.

I agree that if I experience any ill effects with my lashes that I will contact the certified eyelash extension professional that performed this procedure.

I understand that if I experience ill effects it may be beneficial to have the eyelashes removed.

I understand and agree to the after-care instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions and I understand that it may cause the eyelash extensions to fall out and/or decrease the time the lashes will last.

I agree to the following eyelash extension follow-up and maintenance instructions:

No mascara or eyeliner.

No oil-based products around the eye area.

No water can come in contact with the eye area for 24 hours after the application.

Cleaning & Brushing lashes daily.

No tinting or perming of eyelash extensions.

No pulling or rubbing of the eyelash extensions.

Should eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the extensions.

Fills every 1-3 weeks.

I understand that fill pricing is based on retention.

1 week fill must have at least 75% retention.

2 week fill must have at least 50% retention.

3 week fill must have at least 35% retention.

Anything less than 35% retention is a full set.

I understand that if I do not have the expected retention on my chosen fill week I may be charged more for the additional work needed or may need a full set.

I understand that if I do not keep my lashes clean and maintained I may be required to pay for additional lash cleaning “lash bath” at the time of my appointment and/or I may be required to remove my lash extensions and purchase a new set.

 
This agreement will remain in effect for this procedure and all future follow-ups conducted by Alyssa Jones. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I am over 18 years of age (or have consent from my parents/legal guardian) and consent to the agreement and to the eyelash extension application procedure.

Your appointment is very important to us. We understand that sometimes schedule adjustments are necessary. Therefore, we respectfully request at least 24 hours notice prior to your scheduled appointment time for cancellations or rescheduling of appointments. Please notify us by Facebook message, text message if your cancellation is outside of our normal business hours or you're unable to reach us by phone.

ANY APPOINTMENTS CANCELLED/RESCHEDULED OR CHANGED WITHOUT ATLEAST 24 HOURS NOTICE WILL RESULT IN A CHARGE EQUAL TO 50% OF THE SERVICE(S) SELECTED.

ALL "NO SHOWS" WILL BE CHARGED 100% OF THE SERVICE(S) AMOUNT.

We recognize the time of our clients and esthetician/lash Artist is valuable and have implemented this policy for this reason. When you miss an appointment with us, we not only lose your business but also the potential business of other clients who could have scheduled an appointment for the same time.

Please remember that it is your responsibility to remember your appointment dates and times in order to prevent any missed appointments which result in a no show fee. Not receiving an electronic notification of your appointments from us is not a sufficient reason to miss an appointment if the original confirmation notification was received timely.

It is mutually understood that if a cancellation is due to circumstances beyond any of our control, such as power outage, emergency incident, illness, or weather that requires you or us to have to cancel or be closed during regular business hours, we will reschedule your existing appointment and no rescheduling fee will apply.

By signing this agreement I consent to keeping my credit or debit card on file. 

In the event that I breach any booking or cancellation policy's I hereby accept full responsibility and consent to my debit / credit card on file being charged 50% of the appointment total in the event that I cancel or reschedule an appointment  with less than 24 hours notice.
Additionally, I consent to being charged 100% of my appointment total should I No Show / No Call my reserved appointment. 

I have read and understand the cancellation policy and agree to abide by the above conditions.

I hereby grant Alyssa Jones (Johnston)  / Blushing Babes Beauty Bar / Simply You Salon the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures, video, and/or audio is taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social networking sites, and other print or digital communications without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or later discovered. I waive the right to inspect or approve the finished product wherein my likeness appears, including a written or electronic copy. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I hereby hold from all liability, petitions, and causes of action which I,my heirs, representatives, executors, or any other persons may make while acting on my behalf or on behalf of