Refined Eyelash Extensions Agreement & Consent Form

Eyelash Extensions Agreement and Consent Form

Full Name*

Email*

example@example.com

Telephone: (Cell)*

Referred by

Occupation*

Birthday*

I understand this procedure requires single extensions to be glued to my own natural eyelashes. I understand it is my responsibility to keep my eyes closed & be still during the entire procedure, until my eyelash technician allows me to open my eyes. I understand that some risks of this procedure may be but not limited to: eye redness, swelling, irritation. The fumes from the adhesive may cause my eyes to tear up if I open my eyes.

I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.

I understand that I am required to follow the eyelash extension care that is orally given in order to maintain the life of the extensions. I agree that by reading and signing this consent form, I release Venus Manie and Refined Lashes from any claims or damages of any nature. I agree I have read and fully understand this entire consent form. I am of sound mind and fully capable of executing this waiver for myself. I have read and completed the Eyelash Extensions Intake & Consent form in its entirety and have answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that may be caused by the application and/or removal of Eyelash Extensions.

Eyelash extensions are not for everyone. This is a very high maintenance beauty treatment. It requires very gentle care for the lashes to last long and stay in good condition. Once the lashes are attached you must not rub or pull on them. You must not wear any mascara or use Eyelash curlers.

How long do the Eyelashes last?

It is an individual process. We lose one Eyelash almost every day. We also grow a new lash to replace the one that fell out. These Lashes can stay on from 2-3 weeks with proper care and maintenance. However, factors such as eyelash growth, lifestyle and general aftercare will affect how long the lashes last. Please do not attempt to remove any lashes on your own. Seek professional help from your technician to perform this.

WE WILL NOT BE HELD LIABLE FOR ANY DAMAGE THAT YOU MAY CAUSE BY TRYING TO REMOVE THE EYELASH EXTENSIONS ON YOUR OWN.

Do the False Eyelashes damage my natural Eyelashes?

No. The Lash adhesive is formulated to create a solid bond, specifically for human lashes. The adhesive dries very soft on the lashes, allowing the lashes to stay flexible and bouncy just like your own lashes. Due to proper care it's recommended to use a lash shampoo to continue the service over time and washing your lashes. If you have thin or fine lashes you may need to use a lash serum to help stimulate lash growth.

Cancellation Policy:

Should you need to reschedule an appointment, you may do so by providing 24 hours notice, via text, in advance of your appointment. Please contact me immediately to reschedule as my book fills up and I want to accomodate you as best as possible. Life happens, I do understand. But this is a business and I need to be sure you understand that cancellations within the 24hour period will incur a fee. Cronic cancels within the 24hr window will sever the relationship.

Refund Policy:

There are No refunds given for services performed. If you have an issue, please reach out immediately so we may find a solution to the issue.

Consent:

I agree that by reading and signing this consent form, I release Venus Manie and Refined Lashes from any liability claims or damages of any nature.

I agree I have read and fully understand this entire consent form, I am of sound mind and fully capable of executing this waiver for myself.

I have read and completed the Eyelash Extensions Intake & Consent form in its entirety and have answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that may be caused by the application and/or removal of Eyelash Extensions.

I confirm and agree that I wish to engage the services of Venus Manie and Refined Lashes to apply eyelash extensions:

Signature *

I give Venus Manie & Refined Lashes permission to show my before & after photos to other potential clients:*

YesNo

Date*

Date

Allergies*

Type none if N/A

Allergic reactions*

Type none if N/A

Removal of other Salon's work?

YesNo

Glasses or contacts or Both at different times or None

Do you have Dry Eyes?*

YesNo

Lasik in past 6 Months*

YesNo

Have you had Lash-extensions before?*

YesNo

If Yes where?

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Refined Lashes

Venus Manie / Lash Artist

12933 Pomerado Rd., Suite C

Poway, CA 92064