๐๐๐๐๐ก๐ง ๐๐ก๐๐ข๐ฅ๐ ๐๐ง๐๐ข๐ก & ๐๐ข๐ก๐ฆ๐จ๐๐ง๐๐ง๐๐ข๐ก ๐๐ข๐ฅ๐
Client Name
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First Name
Last Name
Birthday
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ย -
Month
ย -
Day
Year
Date
Address
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Street Address
Apartment Number/Unit
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact Name
*
Relationship to Emergency Contact
*
Emergency Contact Number
*
Appointment Date & Time
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ย -
Month
ย -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Instagram
*
Are you booking for Classic Set, Wet Set, Hybrid Set, or Volume Set?
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Appointment takes 2-3 hours. I understand that I must keep my eyes closed and lie still until finished.
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Yes, I can.
Is this the first time youโve had eyelash extensions applied?
*
Yes
No
Are you getting lash extensions applied for a special occassion or daily wear?
Special Occassion
Daily Wear
Do you habitually rub, pull,or pick your lashes?
Yes
No
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๐ ๐๐๐๐๐๐ ๐๐๐ฆ๐ง๐ข๐ฅ๐ฌ
Are you pregnant?
Yes
No
Do you wear glasses?
Yes
No
Do you wear contact lense? (Contact lenses must be removed before your appointment)
Yes I wear contact lense and will remove them prior to my appointment.
No, I do not wear contact lenses.
Do you have, or are you being treated for, any eye illness or injury?
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Yes
No
Do you have any known allergies or sensitives? Please list below
*
Have you ever experienced an allergic reaction to beauty products or salon procedures in the past? Please list below
*
Please list any eye drops or eye medication you are using
*
Please choose any of the following that best describe your skin type:
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Dry Skin
Oily Skin
Oily Eyelid
Oily Hair
Do you have any medical conditions or have had any medical treatment that may make you unsuitable for this appointment? (Thyroid medication, Lasik eye surgery, Blepharoplasty)
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Yes
No
Please choose any of the following that apply to you:
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I use retinoid for skin treatment
I had Blepharoplasty within last 6 months
I had Chemotherapy within last 6 months
I had Lasik Eye Surgery within last 120 days
I had Eyelid surgery for the past 6 months
I have Alopecia
I have Iron deficiency
I have Thyroid disease
I have Pink Eye (Conjunctivitis)
Eczema on lids
Psoriasis on lids
None of the above
Have you been in contact with anyone confirmed to have COVID-19 or MPox in the last 72 hours?
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No
Yes. I need to reschedule my appointment.
Are you experiencing cough, runny nose, or fever?
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No
Yes. I need to reschedule my appointment.
Please be aware that if client has present cough, runny nose, fever, Covid-19 and Mpox symptoms on their appointment, their appointment will be cancelled or rescheduled to a different day.
*
Yes, I understand.
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๐๐๐๐๐ & ๐๐๐๐๐๐
๐ก๐ ๐๐พ๐๐ฝ๐๐๐ ๐บ ๐ฝ๐พ๐๐๐๐๐๏ผ ๐๐๐ ๐๐๐ฝ๐พ๐๐๐๐๐๐ฝ ๐บ๐๐ฝ ๐บ๐๐๐พ๐พ๐ฝ ๐๐ ๐๐๐ ๐ณ๐พ๐๐๐ ๏ผ ๐ฏ๐๐ ๐๐ผ๐๏ผ
๐๐๐ฃ๐ข๐ฆ๐๐ง ๐ฃ๐ข๐๐๐๐ฌ Deposit is to secure a booking reservation. Deposits are non-refundable but is transferrable one time only before it is forfeited. No deposit = No appointment.
*
I agree. I understand.
๐ก๐ข ๐๐จ๐๐ฆ๐ง ๐ฃ๐ข๐๐๐๐ฌ We do not allow companion, children, or pets inside the unit during appointments. For safety and sanitation purposes, only 1 client at a time is allowed inside the unit and we do not have a waiting area. Please plan ahead of time and book a time that works for you.
*
I agree. I understand.
๐๐๐ง๐ ๐ฃ๐ข๐๐๐๐ฌ If youโre running late, please inform us. Each appointment is booked for a certain time, we do not extend your time if you are late. If you are late, your appointment will still finish at the time you are booked until. It is in respect to the client booked after you. We try to accommodate everyone, but if youโre late beyond the time we can accommodate you, we reserve the right to reschedule and forfeit your deposit.
*
I agree. I understand.
๐ฅ๐๐๐๐๐ ๐ฃ๐ข๐๐๐๐ฌ Must have atleast 50% remaining on each eye ON THE TIME of your appointment to be considered a refill otherwise, itโs charged as Full set. Any set that is more than 28 days old from last appointment will be automatically charge as full set.
*
I agree. I understand.
๐๐๐ก๐๐๐๐๐๐ง๐๐ข๐ก, ๐ฅ๐๐ฆ๐๐๐๐๐จ๐๐, ๐ฎ๐ป๐ฑ ๐ก๐ข ๐ฆ๐๐ข๐ช โ You may cancel or reschedule your appointment through text message at 647) 365-5127 but must be done 48 hours BEFORE your appointment time. Failure to do so will result to deposit forfeiture. โ Reschedule is permitted ONE TIME ONLY and reschedule date must be within the next 2 weeks from your original appointment date otherwise, your deposit is forfeited. โ No Show = deposit forfeited and no future appointments.
*
I agree. I understand.
๐ฅ๐๐ฆ๐จ๐๐ง ๐๐ก๐ ๐ฅ๐๐ง๐๐ก๐ง๐๐ข๐ก Results vary in each individual depending on their natural lashes and eye shape. No two sets will be the exact same. It is clients responsibilty to maintain the lashes and proper care for great retention.
*
I agree. I understand.
๐ฅ๐๐๐จ๐ก๐ ๐ฃ๐ข๐๐๐๐ฌ No refund on any services provided. No exception.
*
I agree. I understand.
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๐ช๐๐๐ฉ๐๐ฅ ๐๐ข๐ฅ๐
By checking the boxes below, I, undersigned, understand, consent, and agree with the following statements:
*
I am of sound mind and fully capable of executing this waiver form.
I understand that if I choose to maintain my lash extensions, refills are required every 2-4 weeks. Also if I have less than 40% lash extensions remaining at my fill appointment after grown out lashes removal, I will be charged for a full set.
I understand that there are risks, known and unknown, associated with having artificial eyelashes applied to and/or removed from my natural eyelashes.ย I understand that as part of the procedure these risks may include, but are not limited to, eye irritation, pain, itching, discomfort, an allergic reaction to the adhesive, under eye gel patches, and/or other products used during the procedure and in rare cases eye infection may occur.
I understand and agree that if I experience any of these issues with my lashes, I will contact my technician and have the eyelash extensions removed immediately and consult a physician at my own expense.
I understand and agree to follow the aftercare instructions provided by my technician such as avoiding the eye area getting wet for the next 24 hours after application, avoid mascara or curler, avoid picking and pulling, avoid removing lash extensions with a remover on my own, use non-oil base make up remover, avoid flames, smokes, and heat near the lashes, and washing my lashes with a lash extensions shampoo daily. Failure to follow the aftercare instructions may cause the eyelash extensions to fall out.
I consent to photographs and videos of me being taken and being used by the eyelash technician on social medias and other forms for marketing and educational purposes.
I understand that in order to have the eyelash extensions applied to my eyelashes, I will need to keep my eyes closed for duration of 60-180 minutes during the procedure and that although tearing is normal, it can cause the lashes to bond together rather than one on one. ย ย ย I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes.
This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I understand that this agreement is binding and that I have read and fully understand all information above.
I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the eyelash extension artist's instructions or these warnings.
I release my technician from all liability associated with this procedure. There are no guarantees for the bonding time length of the eyelash extensions. I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.
I also agree to defend, indemnify and hold harmless the eyelash extension technician from any and all claims,actions, expenses, damages and liabilities, including reasonable attorneysโ fees which might be assertedagainst her as a result of my having this procedure performed, or my purchase of these eyelash extension products from her.
I understand and acknowledge that this consent & release discharges my eyelash technician from any liability or claim that I may have with respect to any bodily injury, personal injury, property damage or any other claim that may result from the services provided.
๐ก๐ ๐๐๐๐๐๐๐ ๐ป๐พ๐ ๐๐๏ผ ๐จ ๐๐พ๐๐พ๐ป๐ ๐บ๐ผ๐๐๐๐๐ ๐พ๐ฝ๐๐พ๐ฝ ๐๐๐บ๐ ๐จ ๐๐บ๐๐พ ๐ผ๐๐๐๐ ๐พ๐๐พ๐ ๐ ๐๐พ๐บ๐ฝ๏ผ ๐ฟ๐๐ ๐ ๐ ๐๐๐ฝ๐พ๐๐๐๐บ๐๐ฝ ๐บ๐๐ฝ ๐จ ๐พ๐๐๐๐๐พ๐ ๐ ๐บ๐๐๐พ๐พ ๐๐๐๐ ๐บ๐ ๐ ๐๐๐พ ๐๐๐บ๐๐พ๐๐พ๐๐๐ ๐๐ฟ ๐๐๐พ ๐พ๐๐๐๐๐พ ๐ฟ๐๐๐๏ผ๐จ ๐๐พ๐๐๐พ๐๐พ๐๐ ๐๐๐บ๐ ๐จ ๐บ๐ ๐บ๐ ๐ ๐พ๐บ๐๐ ๐ฃ๐ช ๐๐พ๐บ๐๐ ๐๐ฟ ๐บ๐๐พ ๐บ๐๐ฝ ๐๐๐บ๐ ๐จ ๐๐บ๐๐พ ๐๐๐พ ๐๐๐๐๐ ๐๐ ๐พ๐๐๐พ๐ ๐๐๐๐ ๐บ๐๐๐พ๐พ๐๐พ๐๐๏ผ ๐๐ ๐๐ฟ ๐จ ๐บ๐ ๐๐๐ฝ๐พ๐ ๐ฃ๐ช ๐๐พ๐บ๐๐ ๐๐ฟ ๐บ๐๐พ๏ผ ๐จ ๐๐บ๐๐พ ๐๐ ๐๐บ๐๐พ๐๐ ๐๐ ๐ ๐พ๐๐บ๐ ๐๐๐บ๐๐ฝ๐๐บ๐๐ ๐ผ๐๐๐๐พ๐๐ ๐๐ ๐๐๐๐ ๐บ๐๐๐พ๐พ๐๐พ๐๐ ๐บ๐๐ฝ ๐๐๐ ๐๐ ๐๐พ๐ ๐๐พ๐ ๐บ๐๐๐๐๐๐๐๐ ๐๐ ๐๐พ ๐๐ ๐บ๐ ๐ฟ๐๐ ๐ ๐๐๐๏ผ ๐ก๐ ๐๐๐ ๐๐ ๐๐พ๐ ๐๐๐๐๐บ๐๐๐๐พ ๐ป๐พ๐ ๐๐๏ผ ๐๐พ ๐๐ ๐๐๐พ ๐๐บ๐๐๐ฟ๐๐พ๐ ๐บ๐๐ฝ ๐ผ๐๐๐๐พ๐๐๐ ๐๐ ๐๐๐๐ CLIENT FULL NAME
*
All uppercase letter
0/0
Client Signature
*
Date
*
ย /
Month
ย /
Day
Year
Date
Parent/Guardian Name ๏ผ๐จ๐ฟ ๐ผ๐ ๐๐พ๐๐ ๐๐ ๐บ๐๐ ๐พ๐บ๐๐ ๐ฃ๐ช ๐๐พ๐บ๐๐ ๐๐ ๐ฝ, ๐พ๐๐๐พ๐ โ๐ญ๐๐ ๐ ๐๐๐ ๐ ๐๐ผ๐บ๐ป๐ ๐พโ๏ผ
*
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Parent/Guardian Signature ๏ผ๐จ๐ฟ ๐ผ๐ ๐๐พ๐๐ ๐๐ ๐บ๐๐ ๐พ๐บ๐๐ ๐ฃ๐ช ๐๐พ๐บ๐๐ ๐๐ ๐ฝ๏ผ ๐พ๐๐๐พ๐ โ๐ญ๐๐ ๐ ๐๐๐ ๐๐ผ๐บ๐ป๐ ๐พโ
*
Date
*
ย /
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ย /
Day
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Submit
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