ALL THE FIXINS BY E Eyelashes extensions consent form.
full name
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Name
Last name
Date of Birth ( we have BD coupons)
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cell phone number
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Area Code
Phone Number
Email
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example@example.com
Is this your first time having Eyelash Extensions?
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Yes
No
Do you wear Contacts? _
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Yes
No
Do you have , or are you being treated for any eye illness or injury?
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Yes
No
Please list any eye drops or eye medication you are currently using
Are you pregnant? ?
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Yes
No
What other products do you currently use around your eyes? ( eye creams, oinments, lash growers, etc.
For longevity we recommend not to use mascara ( you're lashes will look so glamorous you won't feel a need to), however if you must, be sure it is oil free and remove it daily with an oil free wash. We recommend our eye wash, or you can may use Sterild or Occusoft ( available at most drug stores).
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Please initial and date you read and understand the above.
The following conditions are not suitable for eyelash extensions.Possible adverse reactions are listed below each condition.
Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may 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 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 last long due to either of these.. _
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Yes
No
Blephoroplasty or other eye condition or surgery in the last 6 months? Blephoroplasty , eye surgery or conditions may have sensitivity to eyelash 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 understand that eyelash extensions require ongoing maintenance. Refills are recommended approx. every 2 /12 to 4 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.
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Initial
I acknowledge and understand that ALL THE FIXINS BY E has a 24 hour cancelation policy. I will be charged 100% of the service if no show and 50% of the service if desired time is not given to reschedule appointment.
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Initial
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
I agree to have eyelash extensions applied to my natural eyelashes and/or removed/retouched. I consent to the placement and/or removal of the eyelash extensions by a lash artist.
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Yes
No
I release my certified lash technician and ALL THE FIXINS BY E 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 tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decided if I am a good candidate for this serive to the best of their ability.
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Initial
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By signing below, I verify that I have read and understand the above statemetns and agree to them. Thank you for the time you took to read, understand and agree to our consent form..
Sign date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client signature
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