Consent Form
Jewels Lash
Name
*
First Name
Last Name
Phone Number
-
Area code
Phone Number
Email
*
Health History - Please check any of the following that applies to you
*
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Eye illness, recent surgery or injury
Blepharitis (inflamed eyelids)
I confirm that I am NOT presenting any of the following Covid-19 symptoms - Cough,Fever,Sore Throat & Runny nose.
Have you ever had eyelashes extensions before?
*
Yes
No
TERMS AND CONDITIONS
*
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
I understand that in rare circumstances eye or skin irritation and discomfort may occur.
I understand that I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.
Signature
*
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
By signing this consent form, I, hereby acknowledge and agree to the terms and conditions above
Submit
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