EYELASH LIFT & TINT

EYELASH LIFT & TINT
CLIENT INFORMATION FORM
Full Name

First NameLast Name
APPOINTMENT TIME
APPOINTMENT DATE

MonthDayYear
Date
ADDRESS
CITY
ZIP / POSTAL CODE
PHONE
Format: (000) 000-0000.
DATE OF BIRTH (DD/MM/YYYY)
CURRENT AGE
Have you ever had a Lash Perm (Lash Lift)?
If YES, when did you have your last lash perm/lift?
If YES, was it a good experience?
If NO, please describe
Have you had a lash/brow tint before?
If YES, did you experience any reaction to the tint?
If YES, please describe
Which best describes the look you would like to achieve for your lashes?
For a more effective, personalized treatment, please be as accurate as possible when filling out the following information

PLEASE CHECK ANY OF THE FOLLOWING THAT MAY APPLY TO YOU
Relating to the Eye:
Generally Relating To Eyelashes:
Other Medical Information
BEAUTY REGIME
Please check all of the below products you use
Please describe any helpful information about your lashes.
CONSENT FOR LASH LIFT & TINT

I UNDERSTAND/AGREE TO THE FOLLOWING COMPLETELY: (PLEASE CHECK EACH STATEMENT)
By signing below, I verify that I have read and understand the above statements and agree to them.
Date

MonthDayYear
Date
By signing below, I verify that I have read and understand the above statements and agree to them.
PHOTO/VIDEO CONSENT FORM
Client Name (please print)
I _______, hereby grant permission to the rights of my image, likeness and sound of my voice as recorded in audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed. I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
PHOTOGRAPHIC, AUDIO, OR VIDEO RECORDINGS MAY BE USED FOR THE FOLLOWING PURPOSES:
I, ___________________, hereby grant permission to the rights of my image, likeness and sound of my voice as recorded in audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed. I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

PHOTOGRAPHIC, AUDIO, OR VIDEO RECORDINGS MAY BE USED FOR THE FOLLOWING PURPOSES:

- Educational presentations or courses
- Informational presentations
- Online educational courses
- Educational videos
- Promotional materials

By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet or in the public educational setting.

- I will be consulted about the use of the photographs or video recordings for any purpose other than those listed above.

- There is no time limited in the validity of this release nor is there any geographic limitation on where these materials may be distributed.

- This release applies to photographic, audio, or video recordings collected as part of the sessions listed on this document only.
By signing this form, I acknowledge that I have completely read and fully understand the above release and agree. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.
CLIENT’S NAME (please print)
Signature
DATE

MonthDayYear
Date
PRECAUTIONARY COVID-19

LIABILITY RELEASE FORM
Due to the 2019 - 2020 pandemic of the coronavirus (COVID-19), we are taking extra precautions as we proceed with each client. We will be implementing additional sanitation and disinfecting practices. Please read, complete the following, and sign below.
SYMPTOMS OF COVID-19 INCLUDE AND ARE NOT LIMITED TO:

- FEVER
- FATIGUE
- SHORTNESS OF BREATH
- DRY COUGH
- SORE THROAT
- BODY ACHES / PAIN HEADACHE
Please check all that apply:
My signature below indicates I agree to each of the above statements and release my technician and the business from any and all liability for the unintentional exposure to COVID-19 virus.
Signature
DATE

MonthDayYear
Date
Your technician and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly prevent the spread of COVID-19 and other communicable conditions.
Should be Empty:

EYELASH LIFT & TINT

CLIENT INFORMATION FORM

BEAUTY REGIME

CONSENT FOR LASH LIFT & TINT

PHOTO/VIDEO CONSENT FORM

PHOTOGRAPHIC, AUDIO, OR VIDEO RECORDINGS MAY BE USED FOR THE FOLLOWING PURPOSES:

PRECAUTIONARY COVID-19