Lash Lift & Tint Intake Form

Name

First NameMiddle NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Have you ever had a Lash Lift and/or Tint preformed before? If so how was your experience?

I would like to preform the service with a sensitivity/patch test prior.

Do you have any allergies or sensitivities? (If so, please specify.)

Are you currently pregnant or breastfeeding?

Are you currently taking any medications or vitamins? (If so, please specify.)

Please select all that may apply.

I understand that a lash lift and tint typically lasts around 6-8 weeks and that the lasting effects depend on my personal lash cycle and no guarantees can be made.

I understand that it is recommended to not wear contact lenses during the service and that they should be removed prior to the start of the service.

I understand that a lash lift and tint is a perming service and it is recommended to use an oil or lash conditioner to maintain lashes post to keep lashes nourished and strong post service.

I understand that my lashes cannot come into contact with water, steam or mascara for at least 24 hours following the lash lift and tint service.

I understand that I should not sleep on my lashes for 48 hours following the lash lift and tint as it can effect the curl and outcome of my lashes.

I understand that in order for The Lunar Cottage to perform a lash lift with or without tint, I will be required to keep my eyes closed for a duration of 1 hour and 15 minutes

I understand that if I sustain an injury due to opening my eyes during the treatment I will hold The Lunar Conage harmless due to prior acknowledgment and warning.

Signature

This agreement will remain in effect for this service and following lash lift services following one year of first service. Forms will be required to update annually.

By signing below. you agree to the following lunderstand this agreement is bindling and that I have read and fully understand all information listed above represent that am over the age of 18.

If under the age of 18 I have had a parent and/or guardian fill this form out below and that he/she consents to this procedure under these terms and will reach out to The Lunar Cottage to further sign paperwork in person.

I have completed this form to the best of my ability and knowledge and agree to inquire with any questions and concerns I have before The Lunar Cottage begins the lash lift and tint service.

I have been informed and understand the contralindications to the requested service and agree that I do not have any condition(s) that would make the requested treatment unsuitable

I will inform my esthetician of any discomfort I may experience during the requested treatment to allow them to comfort and proceed accordingly.

l agree to wave all liabilities toward my esthetician Jordan and The Lunar Cottage for any injury or damages incurred due to any misrepresentation of my health history and not following pre and post care instructions.

Signature

Date