Client Evaluation Form

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Health History - please list any allergies (inc. Cosmetic ingredients) or relevant medical conditions ? (Include any medications used)

How did you hear about us?

Are you allergic to acrylate/cyanoacrylate (bonding agent) ?

Have you ever had any of the following conditions?

Do you wear contacts? If so, you must take them out before booking any kind of eyelash appointment.

What Service are you coming for?

I understand that lash extension, lash lift and lash tint services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging and burning, blurry should the adhesive enter the eye or should an allergic reaction occur.

I understand that some irritation, itching or burning may occur on the skin if the bonding agent comes into contact with it.

I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure.

I consent to “before and after” pictures for the purpose of documentation, potential advertising and promotional purposes.

Eyelash Extensions and Lash Lift & Tint Terms and Conditions

Eyelash Extensions – Terms and Conditions

I agree to give the technician full permission to perform the eyelash extension procedure, and any other procedures here on after.

I understand that a Certified Lash Artist (Esthetician or Cosmetologist) will apply my lash extensions, she/he is trained professionally and there are no refunds to the service, as after care is my responsibility.

I understand that there are many variables including technician expertise, natural lash growth cycle, use of cosmetics and skin care products, and the overall maintenance given that will influence how long my eyelash extensions remain in place.

I understand that there is a potential possibility of allergic reaction -- as with all cosmetic products.

I understand that using mascara on a regular basis will shorten the length of time my extensions remain in place. I have also been advised not to use waterproof mascara on my eyelash extensions.

I understand to not get my lashes wet or apply eye make-up for at least 24 hours after every lash appointment.

I understand that touch-up/fill appointments are necessary as soon as two to four weeks after the applications and when my lashes are at least 50% full.

I understand if I wait too long between fills, it may be a full set charge.

I understand that my eyes HAVE TO remain closed during the entire process, unless directed otherwise.

I understand that this procedure requires single, synthetic lashes being bonded to my natural lash, with other products such as tape, medical tape, adhesive, gel pads, and tweezers.

I am choosing to bypass the patch test option.

I have read this form to the best of my ability. I understand by signing this form, I am relasing Shannon Holmlund from any claims or damages of any nature.

Lash Lift & Tint – Terms & Conditions

I understand to not pluck, pull or cut my natural lashes.

I understand I cannot get my lashes wet or apply eye make-up for at least 24 hours after every lash lift appointment, as it will affect my results.

I understand to come without contacts in or to remove them prior to the service, so there is no irritation.

I agree that if at any time I am uncomfortable with the lash lift or lash tint, I will inform the technician and she will gladly rectify the problem, including ending the session.

I understand there are risks associated with having a lash lift and tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases allergic reaction, eye infection, or blurriness could occur.

I am aware that a lash lift lifts my natural lashes. Depending on my natural lash length and strength, results may differ. I am also aware the lash tint will tint my natural lashes black, blue/back or natural brown depending on my preference.

I understand that Certified Lash Artist (Esthetician or Cosmetologist) will perform the procedure, she is trained professionally and there are no refunds to the service, as after care is my responsibility.

I understand and consent to having my eyes closed and covered for the duration of the treatment. Note - You must prepare your eye area prior to your arrival. Eyelashes should be clean, dry, and free of mascara, makeup, and oil residue.

I release Shannon Holmlund at Ooh La La of all liability associated with this procedure. There are no gaurantees for how long the Lash extentions (2-3 Weeks average) or Lift & Tint (6-8 Weeks average) will last. I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed. I also understand and agree with everything Listed in the terms and conditions

Signature

Client Consent Form

Disclaimer