Eyelash Extensions Intake & Consent Form
Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
I grant permission to Desert Wispies to use my before and after photos for marketing or examples of my technicians work. *We will make you look amazing!*
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Yes
No
I release Desert Wispies 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.
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Initial
I acknowledge and understand that the studio does not offer any refunds. Desert Wispies will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.
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Initial
I acknowledge Desert Wispies does their full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION policies that are also non-refundable agreements of service. If you cancel or reschedule within 2 DAYS before your appointment, a fee will be required upon cancellation (50%). If you cancel often you will be no longer able to book with Desert Wispies. While things may happen, we advise booking appropriately.
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Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 weeks unless stated otherwise by the technician. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set.
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Initial
Is this your first time having Eyelash Extensions?
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Yes (I'm EXCITED!)
No (Always lashes on fleek!)
Are you having lash extensions applied for?
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Special occasion (Places to go.. People to see!)
Daily wear (It's a LOOK necessity)
Do you wear contacts?
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Yes
No
Do you often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have a severe eye illness or are you being treated for an eye injury?
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Yes
No
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. It is important to refrain from sleeping on your face to prevent excessive fall out.
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Side
Stomach
Back
Are you able to lay still on your back for up to 3 hours to have your lashes applied?
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Yes
No
Are you pregnant?
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Yes
No
Please come to ALL your appointments with NO eye makeup and lashes freshly washed. 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.
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Please initial you read and understand the above.
Do you use lash growers or serums such as Latisse or over the counter ones?
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Yes
No
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition
Are you allergic to adhesives (glues, tapes, band aids, etc)? This service uses adhesives in tapes, glues and gel pads that may cause an allergic reaction.
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Yes
No
Have you had Chemotherapy treatments in the last 6 months?
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Yes
No
Have you had Lasik Surgery in the past 4 months?
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Yes
No
Are you currently taking Thyroid Medications?
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Yes
No
Blepharoplasty or other eye condition or surgery in the last 6 months?
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Yes
No
I agree and understand that Desert Wispies is a home based salon and that there are dog(s) (for allergy purposes) who live in the place but will be put away.
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Initial
I agree to Desert Wispies holding my card on file and charging if there is a cancellation or reschedule within 48 hours, or a no show.
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Initial
I agree and understand that Desert Wispies & my lash technician have no way of knowing if the client is allergic to some of the products or materials being used in any eyelash procedure, though we do use sensitive eye products to ensure comfort as every client is different. Desert Wispies does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. 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.
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Initial
Thank you for giving us the time to get to know YOU & signing the consent form, it's much appreciated towards your lash experience!
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By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.
Sign date
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Month
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Day
Year
Date
Client Name
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