3141 E Broad St Suite 303 Room 114, Mansfield, TX 76063
(682) 213-0798
lealux.glossgenius.com
Lash Lift Consent Form
Client Details
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone
*
Please enter a valid phone number.
Email
*
example@example.com
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Consent
Please check each box to show your understanding and agreement.
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Signature
This agreement will remain in effect for this procedure and all future lash lift procedures. I will alert the esthetician if there are any future changes to my medical history. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to the lash lift procedure.
Signature
*
A copy of this signed agreement will be emailed to you.
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