JADASESTHETICS
Boca Raton, FL. | (954)562-6566
NEW CLIENT CONSENT FORM
this is not booking an appointment, please only fill this out if you are a new client with a booked appointment.
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
example@example.com
How did you hear about us?
*
Instagram
Tiktok
Friend
Other
Health History | Please check any of the following that applies to you
*
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you ever had eyelashes extensions before?
*
Yes
No
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)
Yes
No
DISCLAIMER
I take all precautions to ensure your safety and well being before, during, and after your service. Please be aware of the following information and possible risks.
Please agree to the terms and conditions
I 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 understand that results will vary from client to client. Result expectations are not guaranteed.
I will not hold the business or owner responsible for any claim or damage that may occur due to this service.
I give consent to have my photo taken for documentation which may also be used for advertising purposes.
Please confirm you have read over my policies. They are listed on my instagram! These are strictly enforced and nonnegotiable.
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Signature (if under the age of 18 please have a parent/guardian sign below)
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