Consent Form
First Time Clients must complete this form before booking.
Full Name
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First Name
Last Name
Phone Number
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-
Area Code
Phone Number
Email
*
Ex: kenialashedme@gmail.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you ever had eyelashes extensions before?
*
Yes
No
$20 Deposit is required for every appointment.
*
I understand that I must send a $20 Deposit when booking to secure my appointment.
Health History | Please check any of the following that applies to you
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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
None
Other
By checking the following boxes, confirm that you willingly consent to the following 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 @lashesbykenia.
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.
By checking the following boxes, confirm that you willingly consent to having the treatment during the COVID-19 pandemic:
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I am aware of the risks of receiving services during the pandemic.
I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.
I will follow the rules in order to minimize the spread of viruses. I understand that I must wear a mask that covers my mouth and nose during the duration of my appointment.
I do not have any of the following COVID-19 symptoms: cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of tase, lost of smell.
I have not been in contact with anyone that have or may have COVID-19 symptoms or got infected in the past 14 days.
I will immediately notify Kenia if I contract the virus within two weeks following my visit.
I understand I may NOT bring children or anyone else who does not have an appointment into the salon.
Date
*
/
Month
/
Day
Year
Today's Date
By signing I verify that the information I have provided on this form is truthful and accurate. Client Signature
*
Lash Tech Name
First Name
Last Name
Lash Tech Signature
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