Eyelash Extension Consent Form

Name

First NameLast Name

Email

example@example.com

Birthday

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

If a friend referred you please put their name below to be eligible for our referral discount! ( Refer a friend: you and that friend will receive $15 off any service! *The friend that referred you must have recieved at least 1 service from us*)

YesNo

Do you have any allergies? If so, please list them below:

YesNo

Silent no talking & relaxing musicChill music playlist & casual conversationPodcastOther

I understand I have a 3 day grace period starting the day after I get this procedure done. If my lash extensions fall out and/or I am not satisfied with the outcome I will contact Tayla and set up an appointment free of charge to get them fixed.

I understand there are risks associated with having artificial eyelashes applied to and/or removed from my natural eyelashes.

I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the clients natual eyelashes.

I understand and agree that if I experience issues with my lashes that I will contact my technician and have the eyelashes removed immediately and consult a physician at my own expense.

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 and agree to follow the aftercare imstructions provided by my technician. Failure to follow aftercare instructions can cause the eyelash extensions to fall out.

I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for the duration of 60-180 minutes during the procedure. I also understand that I will need to be lying in a reclined position. 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.

This agreement will remain in effect for the procedure and all future procedures conducted by my technician for one year from the date of this signed form. I understand that this agreement is binding and that I have read and fully understand all information listed above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

CANCELLATION/RESCHEDULING GUIDELINES We realize emergencies happen and will be considered, however, it is our business policy to charge a 50% cancellation fee for any cancellations within 24 hours of the scheduled appointment. You will be charged for the full price of the service if you 'no call, no show'. After three online cancellations with no rebook you will no longer have access to online booking. We will require a $30 non-refundable deposit that will go towards the service you want to book. If you need to cancel before 24 hours you will not get the deposit back. You will be allowed to reschedule one time before needing to put down a new deposit.

Today's Date

Date

Signature

Parent or Guardian Signature (If you are under 18 years old, a parent/guardian MUST be present during the appointment)