Lash Lift Consent Form

LASH LIFT CONSENT FORM
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Allergies to adhesive tape, fumes or eye removerDry Eye SyndromeSjorgen's SyndromeCurrently having ChemotherapyOcular Rosacea
YesNo
By signing this agreement, I consent to the procedure of an eyelash perm and/or tint by my technician.I understand there are risks associated with having an eyelash perm and/or tint.I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.I understand that even though my technician perms the lashes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care.I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes. I realize and accept the consequences of failure to adhere to these instructions may cause the lashes to not stay permed as long as told.
No water can come in contact with the eye area for at least 4 hours after the application.Avoid makeup such as mascara or eyeliner for the first 24 hours.Avoid rubbing your eyes. This can cause breakage.Avoid sleeping on your face to avoid kinks in lashes.Brush out lashes twice a day to maintain shape.Apply provided serum nightly to prolong results and keep your lashes healthy (non-negotiable!!)
When to come back for your next lash lift (PLEASE READ):

I recommend waiting 8 weeks before your next lash lift, or until about 80% of the lashes have grown out and look straight. This timing helps prevent overprocessing and damage.

A lash lift doesn’t “fall” — it grows out. Around the 4–6 week mark, you may notice an “awkward phase” where some lashes stay lifted while others grow in straight. This varies depending on your current lash cycle, so it can happen a little earlier or later for everyone. Totally normal and just part of the process!
Acknowledgement and Waiver

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me who consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all the information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for the length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them.
Date

MonthDayYear
Date
Signature*
Should be Empty:

LASH LIFT CONSENT FORM