• ESTHETIC LE LLC

    ESTHETIC LE LLC

  • Lash Intake & Consultation

  • Format: (000) 000-0000.
  • Date of Birth*
     - -

  • Minors(13-17)must fill out a Minors Intake Form with parent/guardian signature.

    click the underline hyperlink above for minors intake form

  • Have you had lash extensions before?*
  • Have you experienced any reactions?

  • LASH CONSULTATION

    The following may determine whether you are an ideal candidate for Eyelash Extensions
  • Do you wear glasses?*
  • Do you use eye drops?*
  • Do you use eye creams/sunscreen?*
  • Do you use Retin-A or Accutane?*
  • Do you use regular sunscreen?*
  • Do you participate in sport/exercise?*
  • Do you spray tan?*
  • Have you had facial treatments?*
  • Have you had botox/filler?*
  • Do you use lash growth products*
  • Do you experience the following? *

  • CONSENT FORM

    Your satisfaction and safety is our number one priority to ensure your wellbeing before, during and after your lash extension application. Please be aware of the following information and possible risks and sign below

  • I understand that this is a semi-permanent procedure

    My natural lashes will continue to grow and fall out naturally, making touchup or “fill” appointments necessary to maintain the original look achieved by replacing the lash extensions that have fallen out. Most clients require a fill appointment every 2-3 weeks to upkeep the look of their lash extensions.

  • I have cited all conditions and circumstances regarding my health history.

    Including: medications being taken, and any past reactions to products or medications that could prohibit or compromise placement and retention of eyelash extensions.

  • I understand that additional conditions could occur which could affect my ability to tolerate the procedure

    In rare cases, eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact my lash technician and it may be beneficial to have the eyelashes removed and seek a medical professional at my own expense.

  • I understand that there are many variables to the overall life of my extensions.

    Hair growth cycle, use of cosmetics, skincare products and the overall care given, will influence how long my extensions remain in place.

  • I understand that aftercare needs to be followed.

    If aftercare is not correctly followed this can result in lash fall out and/or infections through bad hygiene and/or proper maintenance.

  • By signing below you hereby acknowledge and confirm that you are or have been fully informed as to the nature of the service you have requested and are aware with all risks associated. You have informed your technician of any pre-existing conditions, allergies or products sensitivities that may impact on your treatment. We are not liable for any dissatisfaction, discomfort, damage, loss or injury you may incur arising directly or indirectly out of any services provided or any product used. Complimentary services or treatments are only offered on the express understanding that the service offered is not and may not be deemed as an admission of liability or fault and are also subject to the conditions of this agreement.

  • Date*
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  • PHOTO AND VIDEO

    CONSENT & LIABILITY RELEASE
  • Do you give permission pictures and videos for the purpose of documentation, potential advertising on social media/websites, and promotional purposes?*

  • I GIVE permission for ESTHETIC LE LLC to take photographs and video recordings, before, during, and/or after my procedure. I further understand that there will be no financial remuneration.

  • I give permission for photos and videos of my eyes/face to be used for marketing purposes. Photographs taken of me from services that I have received can be used in any print or media including, but not necessarily limited to social media, websites and brochures,

  • I consent that my name and identity may be revealed in descriptive text or commentary. At my request, my identity will remain anonymous.

  • By signing below, I verify that I have read, understand and agree with the above statements.
    I acknowledge my consent as initialed above, and I further recognize this consent form will supersede any other photo consent forms with a date prior to the date written below. This consent may be revoked at any time by request or by completion of a new form.
    Further, I release and discharge ESTHETIC LE LLC of any and all claims or actions that I have relating to such use and publication.

  • Date*
     / /

  • POLICIES

    Our treatments are reserved especially for you. We value your business and ask that you respect & take note of the following Policies before your appointments. Please check each box & SIGN BELOW to confirm you understand each policy.

  • LATE/CANCELLATION/NO SHOWS

  • *

  • When you schedule your appointment with us, you are agreeing to these policies. All services require a credit card to guarantee YOUR APPOINTMENT SLOT. Please have your credit card ready when booking. If you agree to receive emails and texts from us, we have an automated appointment reminder that goes out 24 HRS & 1 HR before your scheduled appointment. You will not be billed unless there is a cancellation or no show. Upon checkout, you may choose your method of payment.

    We accept the following forms of payment: Cash , ZELLE, Credit/Debit Cards, and/or PayPAL

    By scheduling an appointment you understand the policies of ESTHETIC LE LLC and by giving us your credit card to hold on file you understand that if your appointment is missed, you will be charged the full amount of your scheduled service. All walk-outs and cancellations at the time of your scheduled treatment will be charged the full service scheduled. All sales are final.

    Thank you for your understanding.

    ESTHETIC LE LLC

     

  • Date*
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