Denydiva Lash Studio

Denydiva Lash Studio

Consent form
Please provide all requested information and initial and sign where applicable. It is your responsibility to read and understand all information provided in this form. If you have any questions regarding any portion of consent form please send email to info@denydiva.com. Service cannot be provided if form is not on file.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address (please provide at least City,State, Zip)

Street Address

Street Address Line 2

CityState/ Province

Postal / Zip Code
How did you hear about us?*
Referred byblanks (leave blank if not referred by anyone)
What service are you requesting?*

Lash ExtentionsLash Lift
Have you ever worn lash extensions/ received a lash lift?*

YesNo
If yes, is there anything you’d like to share about your past experience?
Leave blank if you’ve never worn lash extensions.
Please all that apply*

Seasonal allergiesDry eyesRecent premanent eye make upRecent eye surgery ( i.e lasik)ContactsSensitive SkinCurrently using lash growth serumSensitivity to adhesives ( medical tapes, bandaids, etc)Acrylic allergyNoneOther
Please list any other allergies or conditions we should know about.
Food allergies and allergies to medications do not need to be mentioned.
Tell me about yourself and what kind of look you’re interested in. ( natural, glam, somewhere in between)
Food allergies and allergies to medications do not need to be mentioned.
I blanks* ( First, Last Name) am 18 years of age or older and agree to have eyelash extensions applied and or removed from my natural lashes. I understand that while rare, there are risks associated with having eyelash extensions applied or removed from my natural lashes. I understand that all efforts will be made by lash technician to avoid discomfort or injury as a result of procedure and release business and professional performing service from any liability.
No guests including children are permitted in treatments area during service. Any guest the accompany you must wait in the designated waiting area.*

I agree
No caffeine prior to service. Caffeine is a stimulant and can cause eyes to flutter during service. This can affect application during service.*

I agree
I will be provided with home care instructions for lash extensions. I understand that not following home care will result in extensions not lasting as long as they should.*

I agree
No make up or skin care products should be worn on or around eye area prior to service. I understand that if any product is on it will be washed off prior to service and potentially cut into service time.*

I agree
Appointments can be rescheduled or canceled for any reason 24 hours or more in advance. Any appointments canceled with less than 24 hours notice are subject to a charge equal to 50% of scheduled services. If late cancel fee cannot be charged a prepayment in the amount of cancel fee will be required in order to book your next appointment. Multiple occurrences may result in a deposit being required prior to any booking or can disqualify you from booking any future appointments.*

I agree
Refund/ Satisfaction Guarantee. No refunds will be offered once service has been completed. If for any reason you are not satisfied with your lash extensions please notify us with in 3 days of service being rendered. Every reasonable attempt will be made to adjust your lashes to your satisfaction. Any requests for adjustment beyond the specified period will be subject to applicable service cost.*

I agree
Lash artist may request to take photos and or videos before during and after service. You agree to allow Denydivas Lash Studio and its employees to use any photos and videos taken for marketing or training materials including but not limited social media content, website, printed marketing/training material.*

I agreeDecline pictures and or video.
This agreement will remain in effect for this procedure and for all future follow-up visits. I am over 18 years of age and consent to this agreement and to the eyelash extensions procedure.*

I agree
Todays date*

MonthDayYear
Date
Signature*

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