Lash Lift & Tint Consent Form

Name

First NameLast Name

Email

example@example.com

Phone Number

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

Do you wear contacts or glasses?

Please list any medications, over the counter or prescription you are currently using

Please list any illnesses or conditions you are being treated by a physician for

Please list any allergies you have

Have you ever had a Lash Lift before?

If you had an adverse reaction to a previous tinting, please explain

Although every precaution will be made to ensure your safety and well-being before, during and after your appointment, please be aware of the possible risks below:

I understand that lifting and tinting lashes has some inherent risk of irritation to the orbital eye including the eye itself, and could result in stinging or burning, blurry vision should the tint enter the eye.

I understand that over the course of several weeks, the lash lift will naturally shed. Lifts should be scheduled every 6-8 weeks to keep them lifted

*Lash Tint* I understand that while every attempt will be made to provide me with my chosen color, hair absorbs color differently and my final results may not be the color I initially wanted.

*Lash Lift +Tint* I understand that over the course of several weeks, the lift and tint will gradually lighten and fade. Tint reapplication will be required to keep the color fresh. Usually every 3-4 weeks.

I have read the above information. If I have concerns, I will address them with my esthetician, Lexi Mireles. I give permission to Lexi Mireles to perform the service we have discussed, and will hold her harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand that my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetician 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 esthetician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of the skin care procedure, which may be affected by the treatment performed today.

Client Name (Signature)

Date

Lexi Mireles- Sun and Sol Studios

Extensions and Lash Lifts and Tints