Consent Form
Please read through terms & conditions before booking your appointment. If not submitted I will not accept your appointment
Name
First Name
Last Name
Email
example@example.com
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Please check the following questions/statements
Have you gotten eyelash extensions before?
Yes
No
If yes, have you ever gotten an allergic reaction before?
Yes
No
Are you pregnant?
Yes
No
The following conditions are recognized as contraindications for eyelash extensions. Please check all that apply or non:
Chronic dry eye
Sensitivities
Seasonal Allergies
Conjunctivitis
Eye infections/disorders
Recent eye surgery
None
Do you give permission to take and use your photo for purposes of documentation, potential advertising and or promotional purposes on social media?
Yes
No
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Please check the following statements below to confirm acknowledgment.
Covid 19 Acknowledgment
I understand that it is my responsibility to defer any appointment to a later date if I have developed symptoms of Covid 19 or any sicknesss.
I understand that if I am showing symptoms of Covid 19 or any sickness I will be rescheduled.
Procedure acknowledgment
I authorize my lash technician to apply or remove eyelash extensions
I understand that some risks of this procedure may be, but are not limited to, eye redness, swelling of eyelids, and irritation. The fumes from the adhesive may cause my eyes to tear up.
I knowingly and freely assume the possibility of an allergic reaction to any of the products used during my service, I will contact my lash technician to assess the situation. A 50% refund be given for an allergic reaction and free removal will be offered.
If retained than less than 40% of my lashes, I may be charged for a full set.
I understand that if I pass the 15minute grace period my appointment will be cancelled, and I will have to schedule a new appointment with a new deposit.
Payment Acknowledgment
I am aware that there is a non refundable deposit of $40, and if I cancel my appointment I will need to send another deposit to reschedule. This is for times I cannot fill your spot.
I understand that my remaining payment transaction will be through square or cash.
If I do not pay IN FULL the day of my appointment, my lash technician has the permission to deny me of any future services.
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