• Eyelash Extension

  • INTAKE FORM

  • Date *
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  • Date of birth*
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you have or have you had any of the following conditions? If yes, please select all that apply:*
  • Are you, or could you be pregnant?*
  • Do you use any of the following products on your eyelashes?
  •  

    By signing below, you agree to the following:

    I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition/s that would make the requested treatment unsuitable or have discussed in detail concerns and potential encounters that my esthetician may have if I follow through with this service. I agree to waive all liabilities toward my technician and the employer for any injury or damages incurred due to any misrepresentation of my health.

  • Our goal is to provide quality care in a timely manner. In order to do so. we have had to implement an appointment/cancellation policy.

    Appointments are in high demand, and your early cancellation will give another person the opportunity to have access to a spot. This policy enables us to better utilize available appointments for our guests. This also applies to arriving on time. We are only able for accommodate late arrivals to a point before it will interfere with the quality of service you will receive and impact the next guest's appointment. So please show up on time! 

    50% nonrefundable and nontransferable fee will be charged for services canceled or no-call/no-show within 24 hour window before appointment. For general courtesy, please give me a 24-48 hour window if possible to cancel your appointment.
    Within 24 hour reschedule is a 50% nonrefundable and non-transferable fee of the scheduled services. If the rescheduled service is outside of the current work week. Meaning Monday through Saturday of current week, there will be a 50% nonrefundable and nontransferable charge for scheduled services rescheduled.
    I have a 5 minute grace. After 5 minutes there is a $7 up charge to your appointment time. No call no-show is considered after 10 minutes past your appointment with no contact. If I am able to service +10 minutes past your originally scheduled appointment time. There will be a $10 convenience fee on top of service price.

     

    For lash extension clients, you should be coming to your appointment with no make up on your lash extensions, and preferably clean skin and eye area free of moisturizers. If you do not come to your appointment with clean well-kept lashes you could be charged an additional $10 convenience fee for a lash bath. 
    For all lash extension appointments, with the exception of full sets, you are required to have a minimum of 40 to 50% of lashes remaining. If you do not have 40 to 50% of remaining lashes you will be charged for a full set.

    I am happy to answer any questions regarding this cancellation policy.

    By signing and dating below you agree to have read and fully understand the above Appointment Cancellation Policy and agree to be bound by it's terms. I agree to pay the cancellation fee in the event of a missed appointment.

  • Date*
     / /
  • I hereby consent to and authorize Alyssa Skene to perform lash extension procedure.

    Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks. Please initial:

    Please initial each statement below:

  • No oil based products around the eye area. No water can come in contact with the eye area for 24-48 hours after the application. No tinting or perming of eyelash extensions. No pulling or rubbing of the eyelash extensions. Avoiding excess steam and he is imperative for longevity of lash extensions. Avoiding oil's and glycerol's on or around eye area will help with longevity of lash extensions. Should any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the eyelash extensions. If you have oily skin you should be cleaning your lashes at least once a day with approved cleanser. All other skin types should be cleansing their lashes daily for health of natural lashes and longevity of lash extensions, with an approved cleanser.

    This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. I understand my lash extension specialist will take every precaution to minimize or eliminate negative reactions as much as possible. I will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. 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 the procedure and accept the risks. I do not hold the lash extension specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure. which may be affected by the treatment performed today. 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 eyelash extension application procedure.

  • Date*
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  • Should be Empty: