Eyelash Extension Waiver

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Who may we thank for referring you?

Have you had lash extensions before?

Do you wear contact lenses?

Do you have or are you being treated for any eye illness or injury?

Do you have any eye sensitivities? (Itchy eyes, hayfever etc)

Do you have any allergies to adhesives, tape, eye pads, or synthetics?

Any medical information we should know about?

I agree to the following:

I understand there are associated with having semi permanent eyelash extensions applied to and/or removed from my natural eyelashes.

I understand that the eyelash extensions will be applied to the eyelash extensions as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the clients eyelashes.

I understand as part of the treatment eye irritation, eye pain, eye itching, discomfort and in rare cases eye infection may occur.

I understand in some cases the eyelash tape may move during the process and in some rare cases the tape will cause an eye cut abrasion, it is best to keep minimal talking during the eyelash application process to avoid this from happening.

I understand and agree to follow the aftercare instructions provided by my technician. Failure to follow aftercare instructions can cause the eyelash extensions to fall out prematurely.

I understand that I have been offered the opportunity to have a patch test of the products being used and have decided to go ahead with the following treatment without the patch test. I accept full responsibility for any reaction which might occur.

I understand the possibility of an allergic reaction, which I will not hold my lash artist responsible for. In the event of an allergic reaction, I understand I will not be given a refund due to the service being completed. I understand and agree that if I experience any of these issues with my lashes that I will contact my technician and have the eyelashes removed immediately and consult a physician at my own expense.

I understand that there are absolutely no refunds.

I understand that lash extensions are not permanent. I will need regular fills to keep them looking their best. I understand that my lashes shed naturally and my extensions will also shed with them. It is normal to lose 1-5 lashes a day per eye.

I understand that if I have any concerns or questions I will contact my lash artist, if any of these symptoms occur and do not go away within 48-72 hours I will seek medical help at my own expense and I will not hold my lash artist Virginia at Lash Beauty Aesthetics accountable.

By signing, I confirm that I have read and understood all the terms and conditions of this service.

Date