Lash extension Form

EYELASH EXTENSION CONSENT AND APPOINTMENT FORM
Client's Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Birthdate
Have you ever had lash extensions before?
If above question is yes: The last place I had lashes applied was at
Do you have lash extensions on at the moment?
A consultation will be done before accepting foreign fills to see if work is compatible!
Do you or have you ever had any allergies or sensitivities? (Previous eye infections, eye disease, allergic to latex, adhesive, etc?)?
List any medications you are currently taking: (some medications can affect retention and break down adhesive used for lashes faster) write none if taking no medication
*
Do you wear glasses?
Do you wear contacts?
Have you received any permanent eye makeup or undergone any eye surgery in the past 6-8 weeks?
The following are contraindications that may prevent lash extensions from being safely applied. Check any that apply and we will go over possible options during the consultation
By clicking the following boxes you agree and confirm that you willingly consent to the following terms and conditions: All boxes must be checked

I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension professional that performed this procedure, and it may be beneficial to have the eyelashes removed.
Photograph and Video Release Form:

I hereby grant and authorize my lash tech the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears.Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording.I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Before Appointment All boxes must be checked

I will come with clean lashes. Coming with clean lashes is pertinent to how well the lashes adhere to your natural lash. Without clean lashes before hand there is less guarantee that you will have as good retention if they are not squeaky clean prior to appointment and all lash fills. I recommend going without mascara at least 24-48 hours before a full set for best retention possible as mascara leaves behind microscopic oily residue that comes between the natural lash and extensions!!
After Care Guidlines for best retention
By Checking the boxes you have read and agreed to the following policies: All boxes must be checked
Use the space below to provide any information we might need to know prior to the appointment.
Referral Program

Reffer a friend and you both receive $5 off your next service!
Date

MonthDayYear
Date
I verify that the information I have provided on this form is truthful and accurate.
Signature
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EYELASH EXTENSION CONSENT AND APPOINTMENT FORM