Eyelash Extension Consultation + Consent Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Type a question
Is this the first time you have had eyelash extensions
*
Yes
No
Do you have any allergies to adhesives, tapes, or synthetics
*
Yes
No
Before my appointment...
*
I will wash my lashes
I will not drink caffeine
During my appointment
*
I wil not wear contact lenses
I will keep my eyes closed
I will lie still
After my appointment
*
I will not pick, pull, or rub my eyelash extensions
I will wash my lashes
I Understand...
$40 Deposit is Non Refundable ( No Exceptions)
Gleam by gigi offers a 10 minute grace period from the time of your scheduled appointment. However, that will cut down on your time of service.
I acknowledge
*
I have been advised of the potential harmful and/or negative side effects (such as premature shedding of my eyelashes) that the lash extension procedure, or removal may cause to those who have specific medical/skin conditions.
The adhesives and adhesive removers are a skin, eye, and mucus membrane irritant, and that in rare cases person may be allergic to, or have hypersensitivity to synthetics, cyanoacrylate, or formaldehyde which may be present in the adhesive.
I have no known medical condition that may aggrevated by the procedure
My eyelash extension artist (Gleam by gigi, Gisela Garcia) will do her best to apply the eyelash extensions and minimize retention issues. However, there are no guarantees for the bonding time length of the eyelash extensions.
The procedure and accept the risk. I do not hold the lash extension artist (Gleam by gigi, Gisela Garcia) responsible for any complications that may arise during or after lash extension application.
This consent form does not have an expiration date
Signature
*
Submit
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