Bat Lashes Lash Extension Waiver
Thank you for choosing Bat Lashes located in Talking Headz Salon
Name
First Name
Last Name
My preferred pronouns are:
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Is this your first time using lash extensions?
Yes
No
If no, why did you remove them?
What products do you currently use or have recently used on you eyelashes? (check all that apply)
Mascara
Curler
Lash Serum
Lash Lift/Tint
Do you wear contacts?
Yes
No
Do you wear glasses?
Yes
No
Have you had any type of eye surgery within the last 6 months?
Yes
No
Do you have frequent eye irritation, itching or watery eyes? (check all that apply)
Eye Irritation
Itching
Watery Eyes
No
How do you usually sleep at night?
Back
Stomach
Left Side
Right Side
Do you have any of the following conditions? (check all that apply)
Allergies to adhesive or synthetics
Dry Eyes
Diabetes
Thyroid Disease
Cancer
Pregnancy
Hypersensitivity to Adhesive, Tape or Gel
Hormonal Imbalance
Sjorgen's Syndrome
List any medications (including supplements) that you are currently using?
I understand and agree to Bat Lashes/Talking Headz Salon's Lash Booking and Cancellation Policy by checking the following box.
That a deposit of $50 must be taken at the time of booking my appointment. Without a deposit on file, I will not be able to book or keep my appointment. That the deposit can go towards my service day of or be carried over to my next appointment. If I no show or cancel my appointment under 48 hours, I forfeit the full $50 deposit.
Please agree to the terms and conditions by checking the boxes:
I consent to have eyelash extensions applied to my natural lashes and/or removed and retouched. I consent to the placement and/or removal of the eyelash extensions by the certified professional.
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. In the very rare occasion eye infection may occur. I agree that if I experience any of these conditions with my lashes, that I will contact the certified eyelash extension professional who performed the procedure and it may be beneficial to have the eyelashes removed.
I agree to the aftercare instructions provided by the certified eyelash professional for use and care of my eyelash extensions. I accept and realize the consequences of failure to adhere to these instructions may cause my eyelash extensions to fall out or decrease the time they will last.
I understand and consent to have have my eyes closed and covered for the duration of approximately 2-3 hours for the procedure. Times may vary depending on the type and number of eyelashes applied. I understand that I will be lying in a reclined position.
I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments as recommended by the certified lash extension professional.
I understand that even though the technician may apply and remove the eyelashes properly, that adhesive materials may become dislodged during or after the procedure, which may irritate my eyes or require further follow up care.
I understand that any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes.
I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure.
PLEASE READ AND CHECK THE FOLLOWING BOXES TO CONFIRM THAT YOU UNDERSTAND AND AGREE TO THESE CONDITIONS. FAILURE TO FOLLOW THESE POLICIES WILL RESULT IN THE CANCELING OF YOUR APPOINTMENT AND THE FORFEIT OF YOUR DEPOSIT :
I will not drink caffeine 6 hours prior to my appointment.
I will wear socks to my appointment. I will wear warm, comfy clothes or bring a blanket, as it tends to get chilly with the necessary humidifier in use.
I will either not wear contacts to my appointment or I will remove them upon arrival.
I will wear a mask upon arrival and throughout my appointment and time in the salon.
I will arrive with my eye area clean. No make up, oils, sunscreen or moisturizers.
I will not put in any eye drops (prescriptions or over the counter) before or at my appointment.
I will bring earbuds to my appointment to help me relax.
I acknowledge that the Lash Extension Technician is a certified professional and should be treated with respect.
Anything you would like to add or think the lash extension professional should know?
Date
-
Month
-
Day
Year
Date
Client Signature
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