Lash Le Volume 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
Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you hear about us?
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Facebook
Instagram
Friend
TikTok
Other
Please list all allergies, medications, products used topically and orally
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If none input N/A
I have listed all allergies, medications and products used topically or orally ingested
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I Agree
I understand that lash extension, lash lift and lash tint services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging and burning, blurry vision should the adhesive enter the eye or should an allergic reaction occur. It is extremely important that eyes remain closed.*
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Agree
I understand that this is a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touchup or “fill” appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks
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Agree
I understand that if I have any concerns, I will address these with my technician Natalie at Lash Le Volume. I give permission to my technician Natalie at Lash Le Volume to perform the lash extension procedure we have discussed. I also consent to “before and after” pictures for the purpose of documentation, potential advertising and promotional purposes. I give permission to my technician Natalie at Lash Le Volume to perform the lash extension procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my lash extension specialist Natalie at Lash Le Volume will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the lash extension specialist Natalie at Lash Le Volume immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. 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. I understand the procedure and accept the risks. I do not hold Natalie at Lash Le Volume my lash extension specialist 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. I understand at Lash Le Volume I am paying for my lash technicians time & skill therefore agreeing to their policy that they do not offer refunds including deposit.
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Yes
Pregnant clients: To prioritize the health and safety of both mother and baby, please note that pregnancy can bring heightened sensitivities to lash products, and services require extended time lying flat. For comfort and safety, a doctor’s note is required before proceeding with lash services
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I agree
Signature
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Submit
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