Eyelash Extension Consent Form
Thank you for choosing Lashes By Lisa
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
Website
Magazine
Web search
Friend
Other
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
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you ever had eyelashes extensions before?
Yes
No
The tape and pads that we use are hypoallergenic. Some people with more severe allergies or sensitivities may feel more comfortable doing a patch test. Would you like to have a patch test done prior to your service? (Note that a patch test does not guarantee that an adverse reaction will never happen)
Yes
No
If you've had lashes before, please tell us about your previous experience. (If possible, include the name of the business and brand that was used)
Please agree to the 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 that my appointment may last several hours. The average time for a full set is 3 hours. Fill times range from 30min-2hrs depending on several factors.
I understand that I will be required to lay with my eyes closed for the majority of my appointment. (bolsters, pillows and blankets are available for comfort)
I understand that I will need to schedule periodic fills with my lash tech to maintain my lash extensions. (Fills are recommended every 2-3 weeks. Mini fills are offered on a weekly basis. If you have not had a fill within 3 weeks, your lash tech will need to access your lashes to determine the cost of your appointment)
I understand and agree to follow the after-care instructions to properly maintain my eyelash extensions. After-care instructions can be found online at youkneadspace.com or given to you at your appointment.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
Date
-
Month
-
Day
Year
Date
Client Signature
Technician Name
First Name
Last Name
Technician Signature
Submit
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