Whimsical Eyelash Consent Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Birthday

(mm/dd/yy)

Please list any prescription medications or vitamins you’re currently taking (be aware that certain medications or medication changes can affect your retention):

N/A if none

Please list any skincare products or topical medications you’re using (please note oil based products can affect your retention):

N/A if none

Please list any medical, skin, or health conditions (including eczema, high blood pressure, etc):

N/A if none

Do you have any allergies (including medication or food allergies)? Any sensitivities to particular products or ingredients? Please describe.

N/A if none

Have you experienced any adverse reactions to lash services in the past? If yes, briefly describe:

N/A if none

Anything else you’d like me to know before your appointment?

N/A if none

BONUS QUESTION: Any essential oil preferences, likes or dislikes? These will never be applied topically, only for aromatherapy purposes.

THE FOLLOWING IS A RELEASE FOR EYELASH SERVICES AND IS REQUIRED FOR YOUR APPOINTMENT. PLEASE READ IN ITS ENTIRETY AND INITIAL BELOW ONCE UNDERSTOOD. THIS WILL NEED TO BE UPDATED ANNUALLY AND WITH ANY CHANGES. CONTACT ME WITH ANY QUESTIONS OR CONCERNS.

I understand that should excessive eyelash fallout occur within the first 48 hours after application, I may contact my esthetician and get scheduled for a free fix within 3 days. If a complaint is made or appointment is scheduled after the 72-hour window, I understand that I am responsible for the full price of a regular fill.

Upon initialing the bottom of this page and filling this form out, I hereby confirm that the information I provided above is accurate to the best of my knowledge. I understand the potential risks associated with eyelash extension services, including, but not limited to itching, some discomfort with application, and in rare cases allergic reaction to glue products. In the event any of these or similar reactions occur, I acknowledge that Whimsical Waxing and Esthetics and its associates are not liable and cannot be held responsible.

I understand my esthetician is well educated and experienced and will consult with me prior to the appointment to help mitigate these problems as much as possible. I have and/or will discuss any relevant medical conditions or concerns with my esthetician, and will disclose any changes regarding medication or topical usage to my esthetician prior to this or any future eyelash extension services.

I consent to undergo the eyelash extension service and release Whimsical Waxing and Esthetics Studio and its esthetician from any liability related to the treatment. I will communicate throughout the appointment should I experience any unusual discomfort or pain, even if this means the service will need to be stopped.

I agree to follow any lash extension aftercare instructions provided by my esthetician and understand that individual results may vary based on hair type, consistency, and skin type.

I understand that at any point in my lash journey, my esthetician may determine that I need a short break to ensure the health of my natural eyelashes. I will comply should this occur.

I understand that no refunds shall be given for services or products for any reason.

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By making an appointment and completing this form, you confirm that you understand that Whimsical Waxing has a 50% fee that you are subject to for same day cancellations or rescheduling within 24 hours.

If you need to make any changes to your appointment, please contact us directly more than 24 hours beforehand.

All no-call, no-show appointments will be automatically charged a 90% fee of the service(s) booked.

Whimsical Waxing operates under a “no refunds” policy for any fees charged or services rendered due to products used, time spent, relevant business costs and losses, and experience of the service provider.

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Whimsical Lash Extension Consent Form