Eyelash Extension Consent Form

Eyelash Extension Consent Form

Thank you for choosing Rosy Wellness & Beauty. We are looking forward to a long and lengthy communication.
Name

First NameLast Name
Phone Number
Email
example@example.com
Instagram
Username
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?

WebsiteInstagramFacebookFriendGoogle AdOther
Have you ever had eyelashes extensions before?

YesNo
Which set of eyelash extensions are you interested in?

Classic eyelash extension full set (1.15-1.45hrs)Hybrid eyelash extension full set (1.45-2.15hrs)Volume eyelash extension full set (2-3hrs)Classic fills from different salon (45-1.30hrs)Hybrid fills from different salon (1-1.45hrs)Volume fills from different salon (1.30-2hrs)Lash extension removal (20-30mins)
Which styles of eyelash extensions are you prefer?

Baby doll eye styleCat eye styleOpen eye styleKitten eye styleNatural eye styleWispy eye styleKim Kardashian Eye Style
Not sure which styles you want? Click here to learn more...

https://www.rosywellnessbeauty.com/styles
Health History | Please check any of the following that applies to you

Allergy to adhesives band aid or medical tapeAllergy to surgical glue or nail glueSeasonal allergiesAllergy to glycerinEye illness or injuryBlepharitis (inflamed eyelids)Permanent eye-makeupEye liftDrugs that can cause temporary hair lossMajor surgery within last 120 daysWear glassesWear contact lensesOther
We appreciate any additional comments or specific details you may have regarding the type of eyelash extensions you desire. Feel free to share any preferences regarding length, curl, thickness, or any specific style you have in mind. Our goal is to ensure that we provide you with the perfect set of eyelash extensions that align with your vision and enhance your natural beauty.
Please agree to the 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.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. Any appointment scheduled beyond the recommended 4-week refill period will be charged as a full set.I Understand that in order to have the eyelash extension applied to my eyelashes will need to keep my eyes closed for duration of 1-3hrs during the procedures conducted by my technician list below.By signing below, I verify that I have read this agreement and fully understand all information above.
Date

MonthDayYear
Date
Client Signature

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Technician Name

Pimporn ( Rose )Jansingharn
Technician Signature

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