Lash Extension Consultation, Consent & Policies.

Consultation Form

Lash Extensions
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Is this the first time you ever had lash extensions applied?
Please Indicate if you have worn these in the last 60 days any of the following types of lashes
Do you curl your lashes?
Do you get lash lifts/ tints?
Do you use lash growth?
Have you had permanent eyeliner applied in the last 30 days?
Have you had eyelash extensions applied for a special occasion or daily wear?
Do you wear contacts?
Do you have frequent irritation, itching or watering eyes?
Have you had an allergic reaction to cyanoacrylate, adhesive or tape?
Have you had Lasik eye surgery in the past 30 days?
Are you pregnant?
Are you able to lay on your back for 1-2 hours?
Do you have any allergies?
If yes, please indicate
Yes No*

Consent Form

Lash Extensions
Although every precaution will be taken to ensure your safety and well-being before, during and after your lash extension application, please be aware of the following information and possible risks.
I understand I need to keep my eyes closed during the entire procedure
I understand that lash extension services have some inherit risk to irritation to the orbital eye area including the eye itself and could result in stinging, burning, or allergic reaction occur
I understand it is a semi-permanent procedure as my natural lashes will continue to grow and fall out normally, making fill appointments necessary to maintain the original look achieved by replacing the lashes that have shedded off or fallen out. Most clients require a fills every 2 weeks
I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure
I consent to “before and after” pictures for the purpose of documentation, potential advertising and promotional purposes
I understand if I have less than 40% of my lashes remaining at the time of my fill appointment that I may be required to pay fullset or higher rate
I agree to the after-care instructions given by the technician and realize that failure to follow these instructions may result in damage to my natural lashes, decrease the life of my lash extensions and/or develop possible eye infections
I understand that it is imperative that I disclose all of the information requested in the consultation form & consent form
I understand that if I have any concerns, I will address these with my technician. I give permission to my technician to perform the lash extension procedure we have discussed, and I will hold her harmless and nameless from any liability that may result from this treatment. I have read and accurately told my technician of any allergies I may have. I understand my technician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I have additional questions or concerns regarding my procedure I will consult my lash technician immediately. I certify I have read, and fully understand the above paragraphs and then I have sufficient opportunity to have any questions answered by signing my name below
Sign here. Thank You!

Booking Policies
48 HOUR CANCELLATION/ NO SHOW POLICY- Should you need to cancel or reschedule your appointment, 48 hours notice is needed before your scheduled appointment time. Any appointment that is canceled less than 48 hours of the scheduled appointment time or any appointment that is a NO CALL/ NO SHOW will be charged a $50 cancellation fee. If no credit card is on file, has expired or declines payment for any reason, you will be required to pay this fee before booking any future appointments. Any client that reschedules their appointment, cancel their appointment, or no-shows for their appointment three consecutive times (this includes any mix of the 3 - reschedule, cancellation or no show), will no longer be accepted as a client. Thank you.
LATE POLICY- In consideration for clients who have services scheduled after you; if you are running late, your service will be shortened by the amount of time. If you’re more than 10 minutes late you will need to reschedule your service and you will be charged a $50 cancellation fee as a NO CALL/ NO SHOW. If no credit card is on file, has expired or declined payment for any reason, you will be required to pay this fee before booking any future appointments.
CHILDREN & EXTRA VISTOR POLICY- Due to safety and liability regulations, I kindly request only those receiving services be present in the salon. Please do not arrive with extra visitors or children.
I understand, I have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing this information may result in contraindications. The services I receive here are voluntary and I release this institution and/or esthetician from liability and assume full responsibility thereof.
Please sign. Thank you!
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Consultation Form

Consent Form

Booking Policies