Lash Lift/Brow Lamination Consent
Do any of the following apply to You?
Eye Allergies or allergies to adhesive tape, fumes or eye remover
Alopecia
Currently Pregnant
Thyroid (any)
Blepharitis
Glaucoma
Radiation
Psoriasis
Currently having Chemotherapy
Ocular Rosacea
Is this your first time getting A lash lift/eyebrow lamination?
Yes
No
If no, did you experience any problems?
Yes
No
Do you wear contacts?
Yes
No
I, undersigned, accept the following statements:
I agree to have an eyelash lift (perm) and/or eyelash tint and/or brow lamination applied to my natural eyelashes and/or retouched. I understand that chemicals used are not approved by the FDA in the United States. I understand that, though very rarely, skin irritation and/or allergic reaction from the chemicals can happen
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been explained to me, along with the risks and hazards involved. Although it's impossible to list every potential risk and complication, I have been informed of possible benefits, risks and complications. I also recognize there are no guaranteed results and the independent results are dependent upon my age, my skin condition, my natural lash/brow cycle and post-treatment care and lifestyle.
I understand my eyes are to remain closed throughout the process while getting my lash lift service done, and that opening my eyes may result in burning due to the chemicals used. I agree as post-lash lift that no water can come in contact with the eye area for 24 hours after the application and I should avoid using oil containing sunscreens, moisturizers and cleansers on my lashes. I understand that this is not a completely permanent application, because of the natural lash/brow cycle including its wear and tear, and that I will have to return every 30 days after this application for further treatments to maintain the expected results. Payment for each treatment is separate.
I have given, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically.
I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: