• Clover Beauty LLC

    Treatment Consent

  • Lash Lift Consent

    Please initial to indicate your acknowledgment
  • I understand that there are risks associated with the lash lifting procedure*
  • I understand that the lashes will be curled with an advanced solution and a conditioning cream*
  • I understand that all conditions must be revealed or disclosed to my esthetician regarding my health history*
  • I understand and agree to follow the aftercare instructions provided by my esthetician and failure to do so may cause an undesirable result*
  • I understand that as part of the procedure eye irritation, discomfort, itching and in rare cases eye infection may occur*
  • I understand that I cannot receive a lash lift procedure if I am in my first trimester of pregnancy*
  • I understand that in order to have a lash lift, I will need to keep my eyes closed for a duration of up to 60 minutes. I also understand that I will be lying in a reclined position. Any medical conditions that may be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure done*
  • I understand that opening my eyes at any point during the lash lift that is not otherwise directed may cause an undesirable result. I agree to keep my eyes closed throughout the procedure unless instructed to do so*
  • I understand that I am not on the medication Thyroxin, if you are on this medication the lash lift may not work*

  • By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive a lash lift treatment from my esthetician/Clover Beauty LLC. I understand that this agreement is binding and will remain in effect for all immediate and future services/procedures received at Clover Beauty LLC. I certify that I have read and understand this entire consent form and I and agree to the information provided in this form. I certify that I am at least 18 years of age and give my consent to treatment. The treatments I receive here are voluntary and I release Clover Beauty LLC and/or the esthetician from liability and assume full responsibility thereof.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: