Lash Lift & Tint Consent Form

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

I am informing my technician of any of the following contraindicated conditions.*

I consent to having my eyes closed and covered for at least 1 hour for the duration of this procedure.*

YesNo

Do you wear contacts?*

No, I do not wear contacts.Yes, but I can wear my glasses instead and take them off during the procedure.

I agree to have an eyelash lift (perm) and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm or eyelash tint by my technician. I understand there are risks associated with having an eyelash perm and/or eyelash tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my lashes or eyes that I will contact my technician and consult a physician at my own expense. I understand that even though my technician perms the lashes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care. I understand and agree to the after care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told.

I agree to the following Post-Lash Lift instructions: During the first 24 hours after the application, avoid eye area contact with water, shampoo, cleansers, sunscreen, heat, oil, lotion, cream, makeup remover, and mascara. Within the first 24 hours, avoid rubbing lashes by sleeping on your back. In general, use an oil-free mascara instead of waterproof mascara. In general, avoid strong sun exposure if you want your lash tint to last longer.

Acknowledgement and Waiver: I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for how long the lash lift and tint will last, however on average it lasts between 6-8 weeks. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as exposing the newly lifted lashes to water, moisture contact, weather conditions, and activities involving high temperatures within the first 24 hours after this procedure. By signing below, I verify that I have read and understand the above statements and agree to them.

Client (or client’s parent) signature*

Date*

Date