Lash Extension Consent Form

Full Name

First name Last name

Cell Phone Number

Area CodeXXX-XXXX

Email

example@example.com

I release my licensed lash technician and Beon Esthetics from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.

Initial

Is this your first time having eyelash extensions?

Do you wear contacts? Contacts should be removed before every appointment.

Do you often rub, pull or pick your lashes for any reason?

Do you have or are you being treated for any eye illness or injury?

Are you pregnant? ?

Are you able to lay on your back and keep your eyes completely closed for 2-3 hours to have your lashes applied?

I understand that failure to keep my eyes completely closed during the process can result in a chemical burn, redness, and/or irritation of the eyes.

Initial

It is recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long.

Initial

For longevity we recommend not to use mascara.

Initial

Do you use lash growers such as Lattice or over the counter ones? It is best to discontinue use of these 2 weeks before you service and discontinue use while you are wearing your lash extensions. Some contain oils and/or steroids and will shorten the duration of your extensions.

How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.

Do you smoke? Please be careful as heat can lead to burning or singeing of lashes. Please also avoid smoking for 24 hours after your appointment as oils and excessive steam can affect retention.

Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.

Have you had Chemotherapy Treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.

Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (gel pads, glues, etc.).

Are you currently taking thyroid medications? Thyroid medications or thyroid conditions may affect the longevity of your set.

Blepharoplasty or other eye condition or surgery in the last 6 months? Blepharoplasty, eye surgery or conditions may have sensitivity to eyelash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service.

Do you have extremely oily skin and/or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, but you will have to wash your lashes more frequently.

I understand that eyelash extensions require ongoing maintenance and that refills are recommended approx. every 2 to 3 weeks. I understand if I go beyond this recommended time I may need a full set.

Initial

I will clean my lashes with an oil-free eyelash shampoo and eyelash cleansing brush at least once a day. (We recommend the Beon Foaming Lash Shampoo for guaranteed squeaky clean lashes!)

Initial

I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.

Initial

I grant permission to use my before and after photos/videos for marketing or examples of my technician's work.

This agreement will remain in effect for this procedure and all future follow-ups conducted by Beon Esthetics in regards to eyelash extensions.

By signing below, I verify that I have read and understand the above statements and agree to them. Thank you for the time you took to read, understand, and agree to our consent form.

Sign date

Date

Client signature

Eyelash Extensions Consent Form

The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition.