Lash Lift/Lamination Consent

TINTING, LASH LIFTING & BROW LAMINATION CLIENT ASSESSMENT & CONSENT

Name

Address

Email

example@example.com

Service to receive (check all that apply)

Although every precaution will be made to ensure your safety and well-being before, during and after your tinting application, please be aware of the possible risks below. By checking the following boxes, confirm that you willingly consent to the following terms and conditions:

Have you ever had your lashes and/or brows tinted?

Have you ever had a lash lift or brow lamination?

If so, were you happy with the results?

Have you ever had an adverse reaction to hair color or previous tinting products? Or any reaction to the perm or neutralizer for lash lift or lamination? If so, please explain

Do you wear contacts? (If so, please remove prior to treatment)

Do you have any eye condition or injury?

Have you undergone any recent eye surgery? (treatment will be postponed if any eye surgery has been performed in the last 6 months)

Please list any medication you are using

Are you allergic to latex or rubber?

If yes, please specify:

Do you have any intolerance/allergy to: (please select all that apply)

If yes, please specify:

I have read the above information. If I have any concerns, I will address these with my Service Professional. I give permission to Lauren Clouse/Megan Burger to perform the procedure as discussed, and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand the professional will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the professional immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand that procedure and accept the risks. I do not hold the professional responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.

Client Signature