• Eyelash Extensions

    Consultation & Consent Form
  •  -

  • Referred by:

  • Have you ever had eyelash extensions?*

  • Client Health History

  • Please list any allergies you have (including cosmetics/ingredients):

  • Are you allergic to acrylate/cyanocarylate (bonding agent)?*
  • Have you ever had a reaction to adhesive tape, topical creams, nail adhesives, or other topical products?*
  • Do you have an eye disease, condition or injury that has affected your hair/lash growth or loss?*

  • Please list all current medications you are taking (including over-the-counter herbs, vitamins and supplements):

  • Have you ever had any of these conditions?*

  • Any other health conditions not listed:

  • Are you pregnant or nursing?*
  • Do you wear contacts?*
  • Do you wear glasses?*
  • Have you ever had Botox, Juvederm or any other injectables?*
  • Which side do you sleep on?*

  • Is there anything else we should know?

  • Post Treatment and Homecare

  • Informed Consent

    Although every precaution will be taken to ensure your safety and well-being before, during and after your lash extension application, please be aware of the following information and possible risks. Please Initial:

  • Cancellation/No-Show POLICY:

    • Recognizing that everyone’s time is valuable. We ask that you provide a 24 hr notice if you are unable to keep your appointment. • Any cancelations or rescheduling with less than 24 hours notice, will be charged 50% of the service price. If payment is not received due to cancelation/reschedule you must pay invoice prior to booking another appointment.  All “NO-SHOWS” will be charged 100% of the service price. • La Belle Esthetics reserves the right to charge the appropriate amount of the service booked for any appointment that is not canceled within the 24 hrs advance notice. • I understand that after 15 minutes of tardiness my appointment may be subject to cancellation and I will be responsible in accordance with the “ No-show” policy.
  • Should be Empty: