Eyelash Extension Consent Form
Thank you for choosing Jas's lashes to service you! Complete this form as a step to book! Esthetician: Jasmine Marenco
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Date of scheduled appointment
*
-
Month
-
Day
Year
Date
Instagram Username for me to contact you!
*
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your age range ?
*
15-22
23-30
31-38
Birthday 🫶🏼
-
Month
-
Day
Year
Date
*Policy and how to prepare for your lash appointment!!* I am agreeing to this by selecting all options below.
*
Submit non-refundable deposit through booking website, if unable to, Zelle $45 non-refundable deposit to jaslashes561@gmail.com as final step to book!
Remove contact lenses, they can dry up, be out of shape, and your eye will then be irritated.
Do not apply any oil based products, this will cause bad retention.
No mascara for three days prior to appointment, this will lead to bad retention, and an additional $10 fee!
No lash strips for three days prior to appointment, this will lead to bad retention, and an additional $10 fee!
No caffeine 24 hours prior to your appointment, your eyes will be jittery and this will lead to your appointment to be pushed longer than scheduled for.
Make sure face is clean with no makeup, this will lead to being sent home or for your appointment to be pushed longer along with an additional $15 fee if I have time to wash your makeup off and then proceed to applying your extentions.
wear comfy clothes - it gets cold
Put your phone on silent
Use the restroom beforehand
Make sure to arrive on time, you will be cancelled if late 15 minutes unless communicated with me and I agree to still servicing you upon your arrival.
service is non-refundable.
How did you hear about me?
*
Instagram
Tik tok
Friend/Family
Other
Health History | Please check any of the following that applies to you. I am informing the eyelash technician professional of the following conditions by selections an option/options below.
*
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
History of recurrent eye or tear infections
History of dry eyes of Sjogren's Syndrome
Recent history of Chemotherapy
Other medical conditions which would prohibit or compromise placement and retentions of eyelash extensions
None of these apply to me
Other
Current Uses | Please check any of the following that applies to you.
*
Current use of contact lenses which I may be asked to remove during the procedure
Current use of anything such as oil-containing sunscreen moisturizers around the eyes
Current use of eye drops of any kind, prescription or over-the-counter
Current allergies or sensitivities
None of these apply to me
Other
I am agreeing to the following eyelash extension follow-up maintenance instructions by selecting all options below
*
No mascara
No oil-based products around the eye area
No water can come in contact with the eye area for 24 hours after the application
No tinting or perming of eyelash extensions
No pulling or tearing of the eyelash extensions
Should any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the eyelash extensions
Must wash at least once a day
Avoid extreme heat to eyelash extensions
Have you ever had eyelash extensions before?
*
Yes
No
If yes, how was your experience with your past lash tech?
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Service Quality
Cleanliness
Responsiveness
Friendliness
Type here what kind of set you’re looking for 💗
If not, would you like to have a patch test which I highly recommend? This is me applying a few extensions (Note that a patch test does not guarantee that an adverse reaction will never happen)
*
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 happens due to not following these instructions are in my own risk such as my eyelash extensions falling out and the decrease of the time the lashes will last.
I understand that in rare occasions there are risks associated with having eyelash extensions. 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.
I understand the consent to having my eyes closed and covered for the durations of the service.
File Upload
Browse Files
Drag and drop files here
Choose a file
Upload confirmation that non-refundable $45 deposit was sent, and if you zelled instead of through the site, please make sure the recipients name appears as “JAS’S LASHES & BEAUTY SERVICES LLC” before sending!
Cancel
of
Are you ok with being posted for content?
Yes
Yes, but just the eyes please
No thank you
What would you say is your natural lash curl? This determines how much time I’ll have to set aside for you!
*
Straight
Just a light curl up but mostly straight
Curly and short
Client's Name . This agreement will remain in effect for this procedure and all future follow ups conducted by the certified eyelash extension professional. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I consent to the agreement and to the eyelash extension application procedure.
*
First Name
Last Name
Client's Signature.
Parent or Guardian if under the age of 18!
First Name
Last Name
Signature
Client's Questions | These will be responded in your DM from Jaslashes_561 or Text from 561-570-6131!
Type "Complete" once you have completed this form, agreed to the policy, read carefully, typed any questions you may have, and have responded what type of natural lashes you have(this is to help me estimate how much time I will have to set aside for you). Thank you for booking, see you soon!
*
Continue
Continue
Should be Empty: