Lash Extensions Intake & Consent Form
Please fill out prior to your first lash appointment with High Vibes.
Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
Important information regarding your appointment. Please read and sign before arrival to your FIRST lash appointment.
Lash Extensions
I grant permission to High Vibes Esthetics to use my before and after photos for marketing or examples of my technicians work. *We will make you look GLAM!*
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Yes
No
I release High Vibes Esthetics from any and all liability associated with this service and future services. This service will be performed with the utmost attention to safety, sanitation, and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.
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Initial
I acknowledge and understand that this service is not eligible for refunds. High Vibes Esthetics will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.
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Initial
I understand the following set CANCELLATION policies that are non-refundable agreements of service. If you cancel or reschedule 24 hrs before your appointment, a 25% fee will be accessed upon cancellation. Second cancellation offense, you will be charged the full appointment amount. After the third cancellation offenseIf you will be no longer able to book any services with High Vibes Esthetics. While we understand that life happens sometimes; communication is encouraged before and after the service, so that we both have a satisfactory experience!
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Eyelash extensions require on-going maintenance. Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set. Please follow after-care guidelines for long-lasting, beautiful lashes!
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Initial
Styles & Preferences
Lash Extensions
Is this your first time having lash extensions?
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Yes (I'm EXCITED!)
No (I can’t go anywhere without them!)
Do you have a lash style already in mind?
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Cat eye (Meeeow!)
Doll eye (Full-glam Barbie girl!)
Surprise me (Best fitting style for your eyes!)
Do you have a lash cleanse kit for at-home care?
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Yes, I regularly cleanse and care for my lashes!
First timer, ran out of cleanser, I NEED THE CARE KIT! ($20)
Do you have a photo reference of the style you had in mind?
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Drag and drop files here
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Accommodations
Lash Extensions
Do you wear Contacts?
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Yes
No
Do you have sensitive and itchy eyes or often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have a severe eye illness or infection or are you being treated for an eye injury?
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Yes
No
Are you able to lay on your back for 2 - 3 hours to have your lashes applied?
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Yes
No
Maintenance & Aftercare
Lash Extensions
How do you usually sleep? Please note, you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most. It is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.
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Side
Stomach
Back
It is recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. We can go over any questions pertaining to your at-home products! Please come to your appointments with no eye-makeup.
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Please initial you read and understand the above.
Do you use lash growth serums? It is best to discontinue use of these type of products 2 weeks before your service and discontinue use while you are wearing your lash extensions. Some contain oils/steroids and will shorten the duration of your extensions. High Vibes Esthetics offers an after-care lash kit at an additional cost.
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Yes
No
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition
Are you allergic to adhesives (glues, tapes, band aids, aromas, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, latex free glue, but allergies may still occur. Scented aroma diffusers may also be used in the room to stimulate calming and relaxing effects.
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Yes
No
Have you had Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. If lashes are in beginning stages to grow back, they may be weak and we recommend waiting until they are strong enough for this service.
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Yes
No
Have you had Lasik Surgery or any eye procedures such as blepharoplasty in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area. (gel pads, glues, etc.) If so, please consult with your doctor before proceeding with this service.
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Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may cause lash extensions to not last as long due to either of these
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Yes
No
I agree and understand that High Vibes Esthetics & my Lash Technician have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. High Vibes does offer patch tests to those that are not sure if they are a good candidate and will offer help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
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Initial
Signature & Consent
Lash Extensions
Thank you giving us the time to get to know YOU & signing this consent form; it is much appreciated towards your lash experience!
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By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to the best of my knowledge.
Sign date
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Client signature
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I'm Ready Girl! XOXO
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