Eyelash Extension Consent Form
Thank you for choosing Rare Lashes. We are looking forward to a long and lengthy communication.
Name
*
First Name
Last Name
Mobile Number
*
04xx xxx xxx
Email
example@example.com
How did you hear about us?
Google search
Flyers
Social Media Ads
Friend
Other
Do you have any allergies?
*
Yes
No
If yes, Please specify
Have you had any eye surgery last 6 months?
*
Yes
No
If yes, Please specify
Have you had eyelash extension before?
*
Yes
No
If yes, Please specify
Do you wear contact lenses?
*
Yes
No
Do you have acrylic allergy?
*
Yes
No
Do you wear glasses?
*
Yes
No
Do you have a latex allergy?
*
Yes
No
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.
Date
-
Month
-
Day
Year
Date
Client Signature
Technician Name
Technician Signature
Submit
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