Eyelashes Extensions Consent Form

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Full Name*

First name Last name

Email*

example@example.com

I release Lash Intimacy Studios from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation, and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. The technician (along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.*

Initial

I grant permission to Lash Intimacy Studios to use my before and after photos for marketing or examples of my technicians work. *We will make you look GLAM!**

YesNo

I acknowledge and understand that the studio doesn’t offer refunds. Lash Intimacy Studios will do their ultimate BEST to provide a service experience to meet your satisfaction and expectations to LOVE your lashes every appointment. *

Initial

Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a full-set.*

Initial

Is this your first time having Eye-lash Extensions?*

Yes (I'm EXCITED!)No (I'm a Diva, I need them 4 EVER!)

Are you having lash extensions applied for?*

Special occasion (Places to go.. People to see!)Daily wear (It's a LOOK necessity)

Do you wear Contacts?*

YesNo

Do you often rub, pull or pick your lashes for any reason?*

YesNo

Do you have a severe eye illness or are you being treated for an eye injury?*

YesNo

How do you usually sleep? Please note, you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most. It is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.*

SideStomachBack

Are you able to lay on your back for 2 - 3 hours to have your lashes applied?*

YesNo

Are you pregnant?*

YesNo

It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long. Let's talk approved products during your appointment. Please come to your appointments with no eye-makeup.*

Please initial you read and understand the above.

Do you use lash growers such as Lattice or over the counter ones? It is best to discontinue use of these type of products 2 weeks before your service and discontinue use while you are wearing your lash extensions. Some contain oils/steroids and will shorten the duration of your extensions.*

YesNo

Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur?*

YesNo

Have you had Chemotherapy treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.*

YesNo

Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area. (gel pads, glues, etc.)*

YesNo

Are you currently taking Thyroid Medications? Thyroid medications or Thyroid conditions may not have lash extensions last long due to either of these*

YesNo

Blepharoplasty or other eye condition or surgery in the last 6 months? Blepharoplasty, eye surgery or conditions may have sensitivity to eye-lash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service*

YesNo

I agree and understand that Lash Intimacy Studios & my Lash Technician have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. Lash Intimacy Studiosdoes offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.*

Initial

Thank you giving us the time to get to know YOU & signing the Consent form, its much appreciated towards your lash experience!*

By signing below, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.

Sign date *

Date

Client signature *

Eye Lash Extensions Intake & Consent Form

The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition