Eyelash Extension Form

Lash Extension Consultation Form

Name

DOB

Email Address

example@example.com

Address

Contact Number

What days or time works best for you?

Do you have a specific style you would like?

Is this the first time you've had eyelash extensions applied?

Have you worn Cluster Lashes in the last 10 days

Have you gotten a lash lift in the last 30 days?

Do you wear contact lenses or glasses?

Do you suffer with trichotillomania?

Do you habitually pull and pick out your lashes?

Compulsive picking and pulling of hair

Do you understand that any of the above can contribute toretention issues or premature fallout of natural lashes?

YesNo

Consent for lash extension application- Initial on Line

I agree to have eyelash extensions applied to my natural lashes. Before my qualified service provider performs this service, I agree to complete this form truthfully and accept all aftercare requirements to protect my investment.

Consent for lash extension application- Initial on LineI agree to have eyelash extensions applied to my natural lashes. Before my qualified service provider performs this service, I agree to complete this form truthfully and accept all aftercare requirements to protect my investment.

Waiver of Liability I understand the potential risks involved with getting professionally applied eyelash extensions. I understand that even with expert application and proper aftercare, there are risks involved with this service such as minor eye pain, discomfort, potential for allergic reactions and

Waiver of Liability I understand the potential risks involved with getting professionally applied eyelash extensions. I understand that even with expert application and proper aftercare, there are risks involved with this service such as minor eye pain, discomfort, potential for allergic reactions and irritation.

Permission to use my photographs- I grant my full permission to take, publish and retouch any photographs of my eyes, eyelashes and face before and after my lash extension service for the purpose of advertising and creating educational material. I also grant permission to retouch any photographs of myself if deemed necessary by my service provider. If you use my photos please:

Aftercare- I agree to accept all aftercare requirements provided below. understand that eyelash extensions require meticulous care. I understand that it is not recommended to ever remove my eyelash extensions at home. If I neglect to take care of my eyelash extensions it will be at my own risk and expense.

No known Medical Conditions ( Informed Consent )- I have read and agreed to this intake form in it's entirety and I have been properly advised of the potential harm or side effects that may be caused by a specific medical condition listed above. I understand that the professional eyelash adhesive, remover or chemicals used on me during the service can potentially irritate the skin, eye or follicles. I understand that in very rare cases, I could be allergic to cyanoacrylate, solvents, tapes or synthetics that are present in

Aftercare:

No picking or pulling your eyelashes Avoid sleeping on one side of your face- use a silk pillowcase to avoid pulling Wash your lashes everyday. The day you get them done, everyday in between and right before your next appointment to ensure great retention. No eyelash curlers. No mascara overtop of your eyelash extensions. Avoid saunas, pool chemicals or extreme heat 24 hours after application.

If for some reason you are suffering poor retention, an irritation or have an issue with your eyelash extensions please contact me directly to resolve this issue immediately.

No known Medical Conditions ( Informed Consent )- I have readand agreed to this intake form in it's entirety and I have been properly advised of the potential harm or side effects that may be caused by a specific medical condition listed above. I understand that the professional eyelash adhesive, remover or chemicals used on me during the service can potentially irritate the skin, eye or follicles. I understand that in very rare cases, I could be allergic to cyanoacrylate, solvents, tapes or synthetics that are present in lash adhesive.

Name

Signature

Date