DIME SALON LASH LIFT CLIENT LIABILITY WAIVER

Please agree to each statement after reading and sign at the bottom:

I understand that there are risks associated with the lash/brow procedure.*

Agree

I understand that the lashes/eyebrows will be treated with an advanced solution and conditioning.*

Agree

I understand that as part of the procedure eye irritation, pain, itching discomfort, and in rare cases eye infection may occur.*

Agree

I understand and agree to follow the aftercare instructions provided by my technician.*

Agree

I understand failure to follow the aftercare instructions may cause an undesirable result.*

Agree

I understand that in certain brow/lash treatments, I may need to keep my eyes closed for the duration of up to 60 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes.*

Agree

I understand that opening my eyes at any point during a lash lift procedure is not recommended, and may cause an undesirable result. I agree to keep my eyes closed throughout the procedure unless instructed to open them by my technician.*

Agree

I am not currently pregnant or breastfeeding.*

Agree

This agreement will remain in effect for this procedure and all future procedures conducted by my technician or any other technician conducting business at Dime Salon Inc. I understand that this agreement is binding and that I have read and understand all information above. I represent that I am over the age of 18 years. If below years of age a parent or guardian must sign this form.*

I release my technician or Dime Salon Inc. liability associated with this procedure. There are no guarantees for how long the treatment will last, on average it lasts between 6-8 weeks. Dime Salon Inc. is not responsible for any technician errors. I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.*

DATE*

Your appointment date. If unknown please put today's date. H

CLIENT NAME*

Full name

EMAIL*

example@example.com

PHONE NUMBER*

Please enter a valid phone number.

PHOTO CONSENT

Yes, you take and share my photoYou can take my photo for your records but please do not shareNo photos please

EMERGENCY CONTACT

Please include a phone number

ALLERGIES AND/OR KNOWN MEDICATIONS*

If you are not sure if it applies, include it just in case.

ADDITIONAL NOTES

Anything you think we should know that we may have left out.

DIME SALON ESTHETICS CLIENT LIABILITY WAIVER