CLIENT CONSENT FORM

Name

First NameLast Name

Mobile Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Recent eye surgery?

Any other conditions not listed?

Please list any eye medication or drops you are currently using

Do your wear contacts or eye glasses?

By submitting the consent form, I certify that I have read and fully understand the above statements and have had adequate opportunity to have any questions or concerns addressed.

I understand the procedure and accept the risks. I understand that this agreement is legally binding. I confirm that I am over the age of 18, of sound mind and fully capable of executing this waiver for myself. (Parental consent will be required if under 18 years old This agreement will remain in effect for this procedure and all future procedures provided by @estheticsbyericaa.

Please read and click the check button to agree the following statements:

I also agree to any image retouching required by the technician, I assign any copyright in the photographs or video to the technician. I agree to defend, indemnify and hold harmless the technician below from any and all claims, actions, expenses, liabilities and damages. Including reasonable attorney fees, which may be osserted against the technician due to this or future procedures or purchase of any products.

Date

Signature

EYELASH CONSENT FORM