GemLashStudio Consent Form

Name*

First NameLast Name

Instagram*

@example

Phone Number*

Format: (000) 000-0000.

Email*

example@example.com

Appointment Date & Time*

ex: 00/00 @ 00:00am/pm

What’s your occasion?*

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

Please list below any and all allergies to adhesives, oil-based products, hair growth/loss medications, chemotherapy treatments, or recent surgeries you may be using or have had within the past 4 months. If none are applicable, please write N/A.*

Are you pregnant?*

YesNo

Have you ever had eyelashes extensions before?*

YesNo

If no, we would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)

YesNo

If yes, where have you had them applied and what brand was used?

I release Gemlashstudio_ 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 temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.*

Initial

I acknowledge and understand that Gem Lash Studio offers a two day fix after my initial appointment and doesn’t offer refunds. Gemlashstudio_ will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment.*

Initial

Please agree to the terms and conditions*

I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.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 hereby understand that Gem Lash Studio is a home based, certified lash artist in the process of becoming an esthetician and fully consent her to apply lash extensions to my natural lashes.I acknowledge that I will be laying on my back for 3.5 hours max. (If breaks are needed please consult with your lash artist)I understand that if I have any irritation or uncomfortable feelings I will immediately contact my lash artist and request for a removal asap.

I acknowledge Gem Lash Studio does their full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION policies that are also non-refundable agreements of service. If you cancel your appointment, $26 deposit will NOT be refunded. You are allowed to reschedule once before another fee is required and it must be prior to 24hrs prior to your appointment. If you cancel/no show more than twice, you will be no longer able to book with Gem Lash Studio. While things may happen, we advise appropriately booking.*

Initial

I understand this form is valid for 6 months from the date of signing. After the 6 months I will need to resign this form again. *

Initial

Thank you for choosing and trusting Gem Lash Studio to do your lashes! We appreciate your time and cooperation in filling out this consent form. Please acknowledge the final statement before signing below:*

By signing below, I verify that I have read and thoroughly understand the statements above. I have answered each question truthfully and to my best knowledge.

Date*

Date

Client Signature*