Lash Extension Consent Form

Lash Extension Consent Form

Magnify Lashes & Beauty
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Please take a moment to answer the following questions
Are you allergic to adhesives (glues, tapes, bandaids, etc)

YesNo
Eyelash extensions uses adhesive tapes, glue, and gel pads that may cause an allergic reaction*
Chemotherapy treatments within the last 6 months?

YesNo
Medication for chemotherapy may cause a reaction to the materials used for eyelash extensions*
Have you received Lasik surgery in the past 4 months? (Must wait 4 weeks post-op exam for medical consent)

YesNo
Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (glues, gel pads) after lasik surgery *
Have you received Blepharoplasty (must wait 6 months post-op for medical consent)

YesNo
Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (glues, gel pads) after lasik surgery*
Do you wear contact lenses?

YesNo
Glue used to apply eyelash extensions may get underneath the contact lens and cause corneal abrasion or scratching. Contact lenses must be removed prior to eyelash extension procedures. *
I agree with If I experience any pain or discomfort during the session, I will immediately inform my lash artist so that the products and/or technique may be adjusted to my level of comfort. I further understand that eyelash extensions have risk of irritation and reaction, especially with other underlying conditions. I understand that I am consenting to the possibilities that are but are not limited to allergic reaction, skin irritation, skin inflammation, and other irritations that can be caused by this service. I consent to all liability in this procedure and understand the risks behind it.
Natural oils will break down the adhesives used to bond the eyelash extensions causing the eyelash extensions to fall out. I understand that this will occur over time, especially if my extensions aren’t cleaned and brushed. I acknowledge that cleaning and brushing my lashes daily will improve the retention of my extensions.

YesNo
No Refund Policy

Thank you for choosing Magnify Lashes & Beauty! Please be aware that we do not offer refunds of any kind. If there is an issue with your lash set, please let your service provider know at the time of service or contact us within 24 hours of your appointment. We are happy to address any concerns and make necessary adjustments within that timeframe.Any concerns raised after 24 hours may require a new appointment and will be subject to standard service charges.Thank you for your understanding and continued support!
Client Signature
Date

MonthDayYear
Date
Should be Empty:

Lash Extension Consent Form

No Refund Policy