Eyelash Extension Consent Form
Thanks for choosing luxbeautybyju
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where did you find me?
A friend
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Other
Health History | Please check the boxes that apply to you.
Allergy to adhesive or tape
Seasonal allergies
Eye Illness
Blepharitis (inflamed eyelids)
Permanent eye makeup
Fluttery eyes
Other
Any major surgeries done in the last 6 months?
Have you had extensions before?
Yes
No
Do you wear contacts
Yes
No
PLEASE AGREE TO TERMS AND CONDITIONS
I 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 Luxbeautybyju by Julia Erhayel is not liable for any unfavorable results
I have read and understand all policy’s
I
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consent to getting Lash extensions done by Julia Erhayel.
Signature
Date
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