• KERATIN LASH LIFT / TINT

  • CLIENT INTAKE

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • If yes, have you ever gotten an allergic reaction?
  • Are you pregnant? (Mark no if you are male)*
  • The following conditions are recognized as contraindications for lash lifts and/or tint. Please check all that apply or none.*
  • CONSENT / WAIVER

  • I, *  , am requesting and consent to have MD BEAUTISTRY perform a lash lift and/or tint on my natural eyelashes (check one)       *    undergoing a sensitivity patch test by MD BEAUTISTRY. (If you marked "with", you must book a separate appointment for the patch test at least a couple days prior to your lash lift/tint appointment.)

  •  Although every precaution will be taken to ensure my safety and well-being before, during, and after the keratin lash lift and/or tint process, I am aware of the following information and possible risks. Please read and initial:

  • By signing below, I hereby acknowledge that I have read and fully understand the above agreement. I have completed this form to the best of my knowledge and agree to inquire about questions I may have before MD BEAUTISTRY begins performing the procedure. I have been informed of and understand the contraindications to the requested treatment(s) and agree that I do not have any condition(s) that would make the requested treatment unsuitable. I will inform my technician of any discomfort I may experience during the requested treatment to allow them to adjust accordingly. I agree to waive all liabilities towards MD BEAUTISTRY for any injury or damages incurred due to any misrepresentation of my health history.

  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • MD BEAUTISTRY POLICIES

    Please read and initial.
  • By signing below, I hereby acknowledge that I have read and fully understand all information and the statements in the agreement above.

    This agreement will remain in effect for this procedure and all future procedures of the same nature conducted by MD BEAUTISTRY. I understand that this agreement is legal and binding. I am over 18 years of age and consent to the agreement and to all policies regarding the keratin lash lift and/or tint service and appointments.

  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • PHOTO AND VIDEO RELEASE

    Please read and initial.
  • By signing below, I hereby acknowledge that I have completely read and fully understand the above release agreement.

  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: