First & Last Name
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Do you wear contacts?
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yes
no
if yes to previous question, contacts must be removed before your appointment to avoid any harm to your eyes.
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I understand
N/A
Do you have any of the following?
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alopecia
thyroid problems
autoimmune disease
none of the above
Do you have any allergies?
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latex
adhesive
seasonal
none of the above
History of eye infections, irritation, or disease?
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yes
no
in order to maintain your extensions, touch up / fill appointments are recommended every 2-3 weeks to keep them full
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I understand
40% of lashes need to be intact to be considered a refill. If less than 40% of lashes remain, a full set will be charged.
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I understand
anything beyond 3.5 weeks is considered a full set, not a refill.
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I understand
Please come to your appointment with clean lashes. If your lashes are dirty with makeup, oil, etc, a $5 lash bath will be charged.
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I understand
RISKS: i understand there are risks of allergic reaction, eye irritation, and / or redness and that I need to remain still with my eyes closed during the procedure. Please notify me if you are uncomfortable and i will stop to allow you to readjust.
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I understand
AFTERCARE: lashes are to be washed daily with proper lash shampoo / lash bath, NOT facial soap, baby soap, or oil based cleansers as these can ruin retention.
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I have a lash bath
I do not have a lash bath
Lash Baths / Lash shampoo is available for purchase from Georgianetics for $10 with a full set, $15 on its own and includes: lash shampoo, & eyelash cleansing brush.
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I understand
Photos are taken for your file / record and may be shared online for marketing purposes. Your face, name, and identity will remain anonymous.
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I understand
ALL services are non-refundable and are to be paid in full before leaving Georgianetics studio.
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I understand
QUALITY GUARANTEE: if there are any problems with your lashes, please let me know within 3 days of your appointment and I can fix them at no cost. outside of the 3 days you will not be covered.
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I understand
Comments
LIABILITY: by signing below, you hereby release any and all persons representing this salon from all claims, demands, damages, actions and causes of actions arising out of the performance of the service.
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i understand
Signature
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Date
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Day
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Month
Year
Date
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