Client Consent Form
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
I understand that there are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes
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Yes, I agree
I understand that each lash set is customized to the client's natural lash health and density, therefore results will vary.
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Yes, I agree
I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash.
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Yes, I agree
I have no known allergic reactions to Latex or Cyanoacrylates
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Yes, I agree
I understand that as part of the procedure eye irritation, pain, itching discomfort and in some cases, allergic reactions may occur.
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Yes, I agree
I understand that I do not currently have any eye disorders such as Pink Eye, Blepharitis, Conjunctivitis, Styes, Active Hay Fever, Alopecia, Chemotherapy, etc.
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Yes, I agree
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 and consult a physician at my own expense.
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Yes, I agree
I understand that lash extension services have some inherent risk of irritation to the orbital eye area, including the eye itself.
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Yes, I agree
I understand that if the adhesive comes into contact with my eyes, the eyes will be flushed with saline water and will seek medical attention immediately.
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Yes, I agree
I understand additional conditions could occur or be discovered during the process, which could affect my ability to continue with the procedure.
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Yes, I agree
I understand that lash extensions is a semi-permanent procedure, I will be responsible to make a fill appointment to maintain the original look.
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Yes, I agree
I understand that lash after-care is very important and instructions will be given by the technician.
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Yes, I agree
Failure to follow the instructions may cause the extensions to fall out, damage, or decrease the time span the set will last.
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Yes, I agree
I consent to before and after pictures for documentation and/or marketing purposes.
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Yes, I agree
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 1-3 hours during the procedure.
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Yes, I agree
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.
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Yes, I agree
I understand a deposit is required by all guests to secure appointments; by agreeing to Hai Lash Society booking/cancellation policy.
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Yes, I agree
I understand I will be granted a 15 minutes grace period for my arrival to the appointment. If I am more than 15 minutes late, the appointment will be cancelled & I will forfeit the full deposit.
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Yes, I agree
I understand a 24 hours notice must be given to reschedule or cancel an appointment without forfeiting the full deposit. If No show/No call, I will also forfeit the full deposit.
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Yes, I agree
I understand that if I am sick or feeling unwell, it is my responsibility to reschedule/cancel before 24 hours of the appointment without getting forfeiting the full deposit.
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Yes, I agree
I understand that if I arrive to the appointment & my technician or Hai Lash Society deemed that I am unwell/unfit to receive eyelash extensions service, I will forfeit the full deposit.
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Yes, I agree
I understand that my Foreign Refill appointment can be changed to a Removal + Full Set or forfeiting the full deposit if my technician deemed that a refill can not be performed due to lash health or bad lash application.
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Yes, I agree
Hai Lash Society understands life happens to all of us, so each guest will be granted ONE free rescheduling pass without forfeiting the deposit. This does not apply for last minute cancellations.
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Yes, I agree
I understand that I can not bring extra guests to the appointment.
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Yes, I agree
I represent that I am over the age of 18 years. If below 18 years of age, I will not able to receive any eyelash procedures by Hai Lash Society.
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Yes, I agree
There is a 5 days guarantee for the bonding time length of the eyelash extensions.
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Yes, I agree
I understand a 5 days eyelash bonding guarantee only applies to on-time arrival to the appointment or be no more than 15 minutes late, and I have follow proper after instructions.
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Yes, I agree
I understand that my complementary 5 days touch up is only 30 minutes. If I arrive past 15 minutes to my appointment or no show, there will not be another complementary service provided by the artist.
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Yes, I agree
Our company or salon is not responsible for any technician errors. I release my technician or Hai Lash Society from all liability associated with this procedure.
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Yes, I agree
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.
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Yes, I agree
I have accurately answered all the questions above. I understand my lash extension specialist will take every precaution to minimize or eliminate negative reactions as much as possible.
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Yes, I agree
In the event I may have additional questions or concerns regarding my treatment, I will consult the lash extension specialist immediately.
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Yes, I agree
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.
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Yes, I agree
I understand that this agreement will remain in effect for this procedure and all future procedures conducted by Hai Lash Society.
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Yes, I agree
I understand that this agreement is binding and that I have read and fully understand all information above.
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Yes, I agree
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.
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Yes, I agree
I understand the procedure and accept the risks.
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Yes, I agree
I do not hold the Hai Lash Society responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.
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Yes, I agree
Signature
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Submit
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