Eyelash Extension Consent Form
@lashesbylally
Full Name
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First name
Last name
Birthdate
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Year
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Phone Number
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Format: (000) 000-0000.
Email
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Emergency Contact
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Terms and Conditions
I grant permission to @LashesByLally to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I release Citlally Sotelo 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 will decide if I am a good candidate for this service to the best of their ability.
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Initial
I acknowledge and understand that this business does NOT offer refunds under any circumstances. We will do our ultimate BEST to provide a service experience to meet your satisfaction and expectations to love your services every appointment.
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Initial
Policies
Please read through carefully. Once you sign this form, you have agreed to all policies.
Deposit Policy
A $20 deposit is required to secure your appointment. This deposit goes towards your service and is only refundable if the appointment is cancelled by the technician. If appointment is cancelled more than 24 hours in advance, the deposit may be returned and/or used for a future appointment within 30 days of the scheduled appointment. If appointment is cancelled less than 24 hours from the service, the deposit will be lost and a new deposit will be required to book another appointment.
Late Policy
Clients will be given a 15 minute grace period before a $10 late fee is added to your service. After 15 minutes, your appointment may be cancelled and your deposit will be forfeited. Please notify me if you are going to be late, I am very understanding and will try my best to accommodate your needs.
No Call, No Shows
No call no shows will be required to pay fifty percent of that appointment before booking another appointment. Notifying me after your appointment time is still considered a no call no show. I understand things can come up last minute causing you to miss your appointment, but please be respectful of my time and notify me that you are not going to make it to your appointment prior to the appointment and/or as soon as possible. One no call no show will be forgiven, however, recurring events will result in my inability to accept you as a client.
Refill Policy
Must have 40% or more of lashes left to qualify for a refill. Clients will be given 3 weeks from the date of their last appointment to get a fill, anything after the 3 week mark will be charged as a full set. Foreign fills are accepted with a reasonable charge of $20 on top of the service price. If a foreign refill could not be done, you will be recommended a removal and new set. Mini refills must have 70% of lashes or more to qualify.
Do you often rub, pull or pick your lashes for any reason? Please note, if you rub, pull, or pick your lashes for any reason it may cause damage to your natural eyelashes.
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Yes
No
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.
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Side
Stomach
Back
It is recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras, eye liners, and crying will loosen the adhesive and your lashes will not last long.
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Please initial you read and understand the above.
The following conditions are not suitable for eyelash extensions.
Are you allergic to adhesives (glues, tapes, band aids, gloves). 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?
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Yes
No
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 not be suitable for eyelash extension application and we recommend waiting until they are strong enough for this service.
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Yes
No
I agree and understand that my licensed esthetician has no way of knowing if the client is allergic to some of the products or materials being used in any eyelash procedure. 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 truthfully and I understand the procedure and risks.
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Initial
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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.
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