• Eyelash Extension Intake & Consent Form

    Appointment Requests & Deposit
    • Personal Information 
    • Consent 
    • I        agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional.  
       
               I understand that in rare occasions there are risks associated with having artifi cial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes, I will contact the certified eyelash extension professional that performed this procedure, and it may be beneficial to have the eyelashes removed.   

               I understand and agree to the aftercare instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out, and/or impact the time that the lashes will last.  

            I understand and consent to having my eyes closed and covered for the duration of procedures for 60 - 180+ minutes or more. Times vary depending on the type and number of eyelashes applied.   

               I agree to inform the eyelash extension professional of the following at time of service:• Current use of contact lenses, which I may be asked to remove during the procedure.• Current use of anything such as oil-containing sunscreen or moisturizers around the eyes.   

               This agreement will remain in effect for this procedure and all future follow–ups conducted by the certified eyelash extension professional. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement.   

               I am 18 years of age or older and consent to the agreement and to the eyelash extension application procedure.

    •  - -
      Pick a Date
    • Powered by Jotform Sign Clear
  • prevnext( X )
      Eyelash Extension Deposit
      $50.00
        
      Total
      $0.00

      Payment Methods

      creditcard
      applePay
      After submitting the form, you will be redirected to Apple Pay to complete the payment.
      googlePay
      After submitting the form, you will be redirected to Google Pay to complete the payment.
      cashApp
      After submitting the form, you will be redirected to Cash App Pay to complete the payment.
    • Should be Empty:
    Jotform Logo
    Now create your own Jotform - It's free!Create your own Jotform