Lash Extension Consultation Form, Consent Form, Covid-19 waiver
  • LASH EXTENSION CONSULTATION FORM

  • Image field 2
  • APPOINTMENT DATE*
     / /
  • Have you had lash extensions in the past? Please mark below.*
  • Do you have any eye conditions, disease, or injuries that has affected your hair/lash growth or loss? Please advise

  • Do you wear glasses?*
  • Do you suffer from allergies (e.g. latex/eyanoacrylate) or hayfever? Please advise

  • *
  • Please mark below
  • Do you give permission to “before and after” photos for the purpose of documentation, potential advertising and promotional purposes?*
  • Do you use Latisse or lash growth products?*
  • Do you experience the following? Please mark below
  • LuxSentials - Where Luxury is Essential

    Mobile: 832-665-8399

    Facebook: www.facebook.com/LuxSentials  

    Instagram: www.instagram.com/Lux_sentials

    Booking Site: LuxSentials.GlossGenius.com/services

    Houston, Texas & Surrounding Areas

  • Image field 18
  • TREATMENT TERMS AND CONDITIONS

    Your satisfaction and safety is our number one priority & to ensure your wellbeing before, during and after your lash extension application. Please be aware of the following information and possible risks. Please initial below.

    explained once this form has been completed. Clients will be given precise aftercare instructions at the end

    I understand that this is a semi-permanent procedure. as my natural lashes will continue to grow and fall out naturally. making touchup or "fill" appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks.

    of the service and following these instructions will ensure the best. most durable

    I have cited all conditions and circumstances regarding my health history. medications being taken. and any past reactions to products or medications that could prohibit or compromise placement and retention of eyelash extensions.

    result. By signing. you are aware of our policies.

    I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure. 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 my lash technician and it may be beneficial to have the cyclashes removed and seek a medical professional at my own expense.

    I understand that there are many variables to the overall life of my extensions including hair growth cycle. use of cosmetics. skincare products and the overall care given. that will influence how long my extensions remain in place.

    I understand that aftercare needs to be followed. If aftercare is not correctly followed this can result in fall out and/or infections through bad hygiene.

    You hereby acknoteledge and confirm that you are or hare been_ fully informed as to the nature of the service you hare requested and are avare with all risks associated. You hare informed your technicion of any pre-existing conditions. allergies or products sensiticities that may impact on your treatment. We are not liable for any dissatisfaction. discomfort. damage. loss or injury you may incur arising directly or indirectly out of any services prorided or any product used. You gire your consent for the use of your details giren for appointment confirmations and in-house promotions. No personal information giren will be disclosed to any 3rd party or used for any specific purpose other than listed abore. Complimentary services or treatments are only offered on the express understanding that the service offered is not and may not be deemed as an admission of liability or fault and are also subject to the conditions of this agreement.

  • CLIENT INFORMATION

  • PROFESSIONAL USE ONLY

  • Image field 22
  • NATURALLASIIHEALTH

  • NOTES/AREAS OF CONCERN

  • WEAK
  • NATURALLASIICOVERAGE
  • NATURALLASILENGTHS
  • LASH

  • LASH STYLE

  • CURLS

  • DIMENSIONS

  • MAPPING STYLE
  • Image field 34
  • Image field 35
  • Image field 36
  • Image field 38
  • Image field 39
  • CLIENT SERVICE HISTORY

  • Image field 42
  • Image field 44
  • Image field 45
  • Image field 46
  • Image field 47
  • Image field 48
  • Image field 49
  • Image field 50
  • Image field 51
  • DATE

  • LENGTHS/DIMENSION/ CURL

  • COVID-I9 LIABILITY RELEASE WAIVER

  • Image field 56
  • There will be extra precautions with the intake of each client. as well as sanitation and disinfecting practices. It is required that you fill out this form and email it back prior to your appointment. Please read the policies. complete the following and sign below.

  • THERE ARE STRICT HYGIENE, AND SAFETY PROCEDURES THAT WILL NEED TO BE FOLLOWED

  • Clients must wear a mask that covers from the bridge of the nose to below the chin. Arrive at your appointment on time. If you arrive early. please wait in your car until you are ealled in. Please do not bring estra guests to your appointment. Temperature checks and hand sanitiser will be provided upon your arrival. Blankets will not be provided for sanitary reasons. Wear warm clothes or bring a blanket if you tend to get cold. Please reschedule as soon as possible if you are feeling unwell or experiencing any symptoms.

  • ADDRESS

  • APPOINTMENT DATE

  • EMAILADDRESS

  • PLEASE CIRCLE YES OR NO TO THE FOLLOWING

  • Have you had any of the following symptoms: Fever/Dry Cough/Tiredness/Difficully Breathing/Shortness of Breath/ Chest Pain or Pressure/Loss of Speech or Morement
  • Have you been in contact with anyone who has travelled in the last 14 days?

  • Have you been in contact with any person who cares for and/or treats

    confirmed or suspected COVID-19 cases?

  • When completing this COVID-19 liability release waiver, you have acknowledged your reponsibilities in managing your own personal health in relation to COVID-19 and do not hold us liable for the possifility of contracting COVID- 19. I confirm that all the above information is true and correct.

  • DATE
     / /
  •  
  • Should be Empty: