💫 Lash Extensions Intake & Consent Form 🤍
Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
I give permission to Allison Erwin to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I release Allison Erwin from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation, and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.
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Initial
I acknowledge and understand that Al’s Esthetic Lounge doesn’t offer refunds. Allison will do her ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.
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Initial
I acknowledge Allison gives her full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION policies that are also non-refundable agreements of service. 30% of your service total is required upon booking ! This deposit is taken out of your overall total ! The deposit is to hold your time and date for your appointment! If you need to reschedule please let me know at least 24hours ahead if possible ! If you no call no show you’ll be blocked from booking ! ! While things may happen, we advise appropriately booking. If it is ever an emergency and something just so happened to come up I am VERY considerate, just communicate with me .
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Is this your first time having lash Extensions?
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Yes
No
Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set.
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Initial
I acknowledge that in order for Allison to do the lash extension service my face has to be FREE of ANY makeup residues or oils .
Please NOTE the times booked are securely yours . If you are late other’s appointment times will be pushed back and causing me to feel rushed . You have a 10 minute grace period if you aren’t here within that 10 minutes your lash service will need to be rebooked which means a new deposit will need to be paid !
I understand that this service can take up too 3 to 4 hours for a FULL set depending on person . Being said so please book your appointments on off days , when you don’t have a busy schedule or when you have a few hours of free time. When applying lash extensions I’m applying to about 200 to 300 single natural lashes while also hand making my own fans .
Do you wear Contacts?
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Yes
No
Do you often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have a severe eye illness or are you being treated for an eye injury?
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Yes
No
How do you usually sleep? Please note, you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most. It is important to refrain from sleeping on your stomach .
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Right Side
Stomach
Back
Left side
Are you able to lay on your back for 3 - 4 hours to have your lashes applied?
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Yes
No
Are you pregnant?
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Yes
No
It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. Please come to your appointments with no eye-makeup.
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Please initial you read and understand the above.
Do you use lash growers such as Lattice? It is best to discontinue use of these type of products 2 weeks before your service and discontinue use while you are wearing your lash extensions. Some contain oils/steroids and will shorten the duration of your extensions. There is eye-lash extensions approved products for your natural lashes that we can recommend while you have extensions.
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Yes
No
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition
Are you allergic to (adhesives glues, tapes, gel pads) etc ? This service may use adhesives tapes, glues and gel pads that could cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.
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Yes
No
Have you had Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.
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Yes
No
Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area. (gel pads, glues, etc.)
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Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may not have lash extensions last long due to either of these
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Yes
No
Blepharoplasty or other eye condition or surgery in the last 6 months? Blepharoplasty, eye surgery or conditions may have sensitivity to eye-lash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service
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Yes
No
I agree and understand that Al’s Esthetic Lounge (Allison Erwin) has no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. Allison does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
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Initial
Thank you giving me the time to get to know you & signing the consent form, its much appreciated ! XOXO - Al
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By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.
Sign date
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Month
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Day
Year
Date
Client signature
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submit to slay them lashes sis
submit to slay them lashes sis
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