Eyelash Extension Consent Form

Eyelash Extension Consent Form

New Client Form
Name

First NameLast Name
Phone Number
Email
example@example.com
Address

Street Address

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CityState / Province

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How did you hear about Chu Lash?*

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Health History | Please check any of the following that applies to you

Allergy to adhesives or medical tapeAllergy to surgical glue or nail glueSeasonal allergiesAllergy to CyanocrylateBlepharitis (inflamed eyelids)Drugs that can cause temporary hair lossMajor surgery within last 120 daysOther
Have you ever had eyelash extensions before?*

YesNo
If not, would you like to have a patch test which is highly recommended free of charge? (Note that a patch test does not guarantee that an adverse reaction will never happen)*

YesNo
If not, would you like to have a patch test which is highly recommended free of charge? (Note that a patch test does not guarantee that an adverse reaction will never happen*

YesNo
Prior to your appointment:

● I don’t take foreign fills from another lash artist. If you have lash extensions from another lash tech, please book with me for a removal and a brand new full set to ensure your lashes look their best.

● Please make sure you come to your appointment with a clean face and remove all makeup (especially water proof mascara). Removing mascara can be very time consuming and any residual makeup will prevent proper application of the extensions. Use a mild, oil-free cleanser. Do not use oil-based makeup removers.

● Come on time to your appointment. No more than 10 minutes late without contacting me (443-416-3711) or your appointment will be cancelled.
Cancellation / Rescheduling Policy

● I strive to accommodate my clients to the best of my ability. All of my appointment confirmations are sent via text or email. Please honor your appointment. If you must cancel or reschedule, please do so at least 24 hours before your appointment. (443-416-3711)

● No call/no shows will not be allowed to book another appointment with me so please make sure if you have to cancel, let me know.
What Causes Lash Allergy or Lash Allergic Reaction?

Eyelash extension allergies may be triggered by your body’s reaction to the chemicals in the lash adhesive. In the adhesive, there are chemicals called cyanoacrylate and carbon black. Cyanoacrylate is a bonding chemical that gives the adhesion to the glue. Carbon Black is the black color of the glue. All eyelash extension glue has about 90% or more of Cyanoacrylate. Sensitive glue has less percentage of Cyanoacrylate. Therefore, the adhesion or retention is less than normal glue in this aspect (lashes shed faster because the bonding is not as strong.)

Though there is no direct glue being dropped in your eyes (it might feel like it due to the stinging). It is actually the VAPOR of the glue that can trigger your allergy if you are sensitive.
The shedding process of your natural lashes:

The shedding process of your natural lashes is a normal part of the hair growth cycle. Each of your natural lashes has a growth phase, a resting phase, and a shedding phase. During the growth phase, your natural lashes will continue to grow in length and thickness until they reach their full potential.

Next, during the resting phase, the lashes will stop growing and remain at their full length and thickness for several weeks. After this, the shedding phase begins, and the lash will naturally fall out, making room for a new lash to grow in its place.

On average, each of your natural lashes has a lifecycle of approximately 60-90 days before it naturally sheds and is replaced by a new lash. This means that you can lose up to 20-30% of your natural lashes during this time.

The shedding process can be influenced by several factors, including genetics, age, hormones, and external factors such as stress and medical conditions. Additionally, rubbing or pulling on your lashes or using harsh products around your eyes can also speed up the shedding process.

It's important to note that when you have lash extensions, the extensions are attached to your natural lashes, and as a result, some of the extensions will fall out naturally along with your natural lashes during the shedding process. This is a normal and expected part of the lash extension process and is nothing to worry about.

To help minimize the impact of the shedding process on your natural lashes and lash extensions, it's important to take good care of them. This includes being gentle when cleaning them, avoiding rubbing or pulling on your lashes, and avoiding oily products around your eyes.
AFTER-CARE INSTRUCTIONS FOR EYELASH EXTENSIONS

Gentle care is essential to guarantee that the lashes stay longer and are in good shape.

* Keep the extensions dry for 4 to 6 hours after the appointment.

* Take care of your eyelashes, avoid rubbing or pulling them and no lash perming.

* You should avoid using any oil-based products on your lashes. Because of the oil, the adhesive will break down, causing the lash extensions to fall out.

* Within 4 to 6 hours of lash application, no saunas, facials, or swimming in the pool.

* Avoid lowering your head into the oven if you're baking. It will likely burn your extensions. Turn your head away from the oven or stove when putting something in or taking something out.

* Do not use curlers.

* Instead of attempting to remove extensions on your own, book an appointment with your lash artist.

* After the application of eyelash extensions, brush your lashes daily. Brushing takes care of the most lash issues. Brush your lashes gently if you see anything unusual with them.
Please agree to the terms and conditions*

I have voluntarily chosen to receive eyelash extension services from Chu Lashes.I understand and acknowledge that the application of eyelash extensions involves the use of adhesive and synthetic lashes, which will be attached to my natural lashes.I acknowledge and understand that there are risks associated with the application of eyelash extensions, including but not limited to eye irritation, discomfort, or injury due to the application of the lashes or the adhesive used. If I decided to refuse the patch test, I accept the responsibility of any irritation due to the adhesive used.I acknowledge and understand that it is my responsibility to disclose any relevant medical information, including allergies or sensitivities, that may affect my ability to receive eyelash extensions.I have been informed of the aftercare instructions, and I agree to follow them to ensure the longevity and health of my natural lashes and extensions.I hereby release Chu Lashes, from any and all liability for any injury, damage, or other harm that may occur during or after the lash extension service.I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.I acknowledge and understand that I have the right to stop the application at any time and have the extensions removed.I understand that it takes 4 to 6 hours for the adhesive to cure thoroughly and avoiding contact with direct excessive moisture for longer than a minute within the initial 24hrs post application, ( i.e water, steam, swimming, sauna use or tears to eliminate the risk of interference with this curing process), which may result in weaker bond, premature lash extension loss, and or irritation.I understand that while every attempt will be made to provide me with the length and fullness I have chosen, my final result may not be what I initially envisioned due to my eye shape, quantity of my lashes, etc.I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.I understand I have up to 72 hours after my service to contact Chu Lashes in case I have lash retention issues to receive a fix free of charge. Passed 3 days of my service, they can be fixed at a discounted fee. Chu Lashes does not offer lash fix after 7 days of services.I may have additional questions or concerns regarding my treatment, I will consult the lash extension specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the lash extension specialist responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.
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