Eyelash Extension Consent Form
Full Name
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First name
Last name
Cell Phone Number
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Format: (000) 000-0000.
Email
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example@example.com
Instagram Handle
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@example123
I grant permission to Lashed by Victoria to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I release Victoria Huse 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.
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Initial
I acknowledge and understand that this studio does not offer refunds under any circumstances. We will do our ultimate BEST to provide a service experience to meet your satisfaction and expectations to love your lashes every appointment.
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Initial
Policies
Please read through carefully. Once you sign this form, you have agreed to all policies.
Deposit Policy
A $30 nonrefundable deposit is required within 2 hours of booking to secure your appointment. This deposit goes towards your service and is only refundable if the appointment is cancelled by the technician. If appointment is cancelled more than 24 hours before the service, the deposit may be used for a future appointment within the same month. Deposit is only transferable once. If appointment is cancelled within 24 hours of the service, the deposit will be forfeited and a new one will be required to book another appointment.
Late Policy
Clients will be given a 10 minute grace period before a $15 late fee is added to your service. After 15 minutes, your appointment is cancelled and your deposit is forfeited. Please notify me if you are going to be late. I am very understanding and will try my best to accommodate you.
No Call, No Shows
No call no shows will be required to pay 50% of the services booked in order to schedule another appointment. If it occurs a second time, you will be charged for 100% of the services booked. Failure to pay = Banned from booking. Notifying me AFTER your appointment time is STILL a no call no show. I understand things can come up last minute causing you to miss your appointment, but please be respectful of my time and notify me that you are not going to make it to your appointment as soon as possible.
Fill Policy
Must have 40% or more of lashes left to qualify for a fill. Clients will be given 3 weeks from the date of their last appointment to get a fill, anything after the 3 week mark will be charged as a full set. No foreign fills, you will be charged for a removal. Mini fills must have 70% of lashes or more to qualify.
Other Policies
Mask is required. Please no guests including kids. I will either ask your guests to wait in the car or I will turn you away. If you have any COVID-like symptoms or symptoms of ANY kind, please be considerate of my and my family's health and cancel your appointment. If you need to reschedule your appointment due to feeling sick, I will gladly allow you to use the same deposit. ALL SERVICES ARE NONREFUNDABLE.
I have read through and acknowledge all enforced policies.
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Do you often rub, pull or pick your lashes for any reason?
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Yes
No
How do you usually sleep? Please note, you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most.
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Side
Stomach
Back
It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras, eye liners, and crying will loosen the adhesive and your lashes will not last long.
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Please initial you read and understand the above.
Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that 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 Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.
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Yes
No
I agree and understand that my Lash technician has no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure. 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
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By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.
Sign date
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Month
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Day
Year
Date
Client signature
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Submit
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