Lash Extension Consent Form

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Miss Minx LLC* This field is required.Eyelash Extension Consent Form
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email
example@example.com
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Please Provide Emergency Contact Information
First Name
Last Name
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Emergency Contact Phone Number
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Do you wear contact lenses? * This field is required.
YESNO
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Have you had eyelash extensions before?
YESNO
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If so, specify any reactions or sensitivities* This field is required.
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Do you have any allergens? If so, specify:* This field is required.
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Any eye problems in the last 4 weeks?
YESNO
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Do you use eye products? * This field is required.E. G drops?
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CONSENT

I UNDERSTAND THAT THIS PROCEDURE REQUIRES SINGLE SYNTHETIC LASH HAIR TO BE GLUED TO MY OWN NATURAL EYELASHES.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO KEEP MY EYES CLOSED & BE STILL DURING THE ENTIRE PROCEDURE, UNTIL MY EYELASH TECHNICIAN ADDRESSES ME TO OPEN MY EYES.

I UNDERSTAND THAT SOME RISKS OF THIS PROCEDURE MAY BE BUT NOT LIMITED TO EYE REDNESS & IRRITATION. THE FUMES FROM THE ADHESIVE MAY CAUSE MY EYES TO TEAR UP IF I
OPEN MY EYES.

I AGREE TO DISCLOSE ANY ALLERGIES THAT I MAY HAVE TO LATEX, SURGICAL TAPES, CYANOACRYLATE, VASELINE, ECT.

I UNDERSTAND THAT I AM REQUIRED TO FOLLOW THE EYELASH EXTENSION CARE INFO IN ORDER TO MAINTAIN THE LIFE OF THESE EXTENSIONS.

I AGREE THAT BY READING & SIGNING THIS CONSENT FORM, I RELEASE ASHTONETTE SINGLETON FROM ANY CLAIMS OR DAMAGES OF ANY NATURE.

I AGREE THAT I READ & FULLY UNDERSTAND THIS ENTIRE CONSENT FORM.

I AM OF SOUND MIND & FULLY CAPABLE OF EXECUTING THIS WAIVER FOR MYSELF.

I GIVE ASHTONETTE SINGLETON PERMISSION TO SHOW MY BEFORE & AFTER PHOTOS OF EYELASH EXTENSIONS TO OTHER POTENTIAL CLIENTS.

I HAVE READ & COMPLETED THE EYELASH EXTENSION INTAKE & CONSENT FORM IN ITS ENTIRETY, & HAVE ANSWERED EVERYTHING TO THE BEST OF MY ABILITY. I HAVE BEEN INFORMED OF POTENTIALLY HARMFUL OR NEGATIVE SIDE EFFECTS THAT MAY BE CAUSED BY THE APPLICATION AND/OR REMOVAL OF EYELASH EXTENSIONS.

I CONFIRM & AGREE THAT I WISH TO ENGAGE THE SERVICES OF MARIA GUDINO TO APPLY EYELASH EXTENSIONS.

ASHTONETTS SINGLETON HAS BEEN TRAINED BY A PROFESSIONAL AND LICENSED ESTHETICIAN AND IS CERTIFIED TO PERFOM THIS SERVICE.
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PAYMENT & CANCELATION POLICY

POLICIES
Guarantee: Miss Minx Lashes, strives for the best quality and Lash Services. If you have any concerns with the service you received, let me know within 3 days and I will fix it to your satisfaction at no extra charge. This is a policy I stand by!

Appointment Policy: Miss Minx Lashes, requires all appointments to be reserved with a credit or debit card.

Cancellation Policy: Miss Minx Lashes requires 48-hour notice prior to any cancellation or rescheduling an appointment. Cancelling within 4 hours of your appointment will be considered a no-show and those fees will apply. Failure to give 48-hour notice will result in 50% of the scheduled service fee. No-shows will be charged 100% of the scheduled service fee.

Late Policies: Please notify us if you are running late for your appointment. Running late may result in your service being altered to fit the remaining time available. If you are at least 30 minutes late, your appointment will be treated as a no-show and you will be charged full prices for service missed.

Refunds: Miss Minx Lashes, does not offer refunds on services. We do however, offer SERVICE CREDIT of 50% towards another Apllication.

Allergies: If you experience an allergic reaction to any of the products used during a service, please notify me immediately for assistance in assessing the situation. If you have experienced allergic reactions to eyelash extensions in the past and think you may have an allergy to our products, please let us know prior to your appointment. A patch test can be administered before your appointment. Simply phone or email us with this request. *Refunds are not given for allergic reactions.

Children: SORRY I cannot accommodate small children while perfomring services as I am unable to supervise. Thank you for your consideration.
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Signature* This field is required.
Clear
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Date
Date
Year
Month
Day
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Appointment
Should be Empty: