EYE LASH EXTENSION FORM
Thank you for choosing TBABES LASH CO. We are looking forward to a long and lengthy communication.
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Health History | Please check any of the following that applies to you
I CONSENT TO THE APPLICATION, REMOVAL, AND/OR RETOUCHING OF EYELASH EXTENSIONS TO MY NATURAL EYELASHES BY THE CERTIFIED EYELASH TECHNICIAN LISTED BELOW.
I UNDERSTAND THERE ARE RISKS ASSOCIATED WITH THEAPPLICATION/REMOVAL OF EYELASH EXTENSIONS. INCLUDING, BUT NOT LIMITED TO: EYE IRRITATION/DISCOMFORT.
I UNDERSTAND AND CONSENT TO HAVING MY EYES CLOSE THROUGHOUT THE PROCEDURE.
I AGREE TO THE AFTER-CARE INSTRUCTIONS GIVEN BY THE TECHNICIAN AND REALIZE THAT FAILURE TO FOLLOW THESE INSTRUCTIONS MAY RESULT IN DAMAGE TO MY NATURAL LASHES, AND/OR DECREASE THE LIFE OF MY EXTENSIONS.
I CONSENT TO HAVING BEFORE AND AFTER PICTURES TAKEN FOR ADVERTISING AND MARKETING PURPOSES. I UNDERSTAND THAT THESE PICTURES MAY BE POSTED TO SOCIAL MEDIA OUTLETS.
FIRST TIME WEARING EYELASH EXTENSIONS?
Yes
No
CURRENT USE OF EYE MEDICATION OR ANTIBIOTICS?
Yes
No
FREQUENT EYE IRRITATION, WATERY EYES, AND/OR ITCHY EYES?
Yes
No
DO YOU WEAR CONTACTS?
Yes
No
DO YOU WEAR CONTACTS?
Yes
No
RECENT HISTORY OF CHEMOTHERAPY?
Yes
No
ANY EYE SURGERY WITHIN THE LAST 6 MONTHS?
Yes
No
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 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 occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.
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Month
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Client Signature
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