Lash Extension Consent Form

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Do you have any allergens? If so, specify:

latex or eyelashes products allergy, pet allergy, reactions or sensitivities

Had you ever have eyelashes extension before? Yes/No/Any emergency contact?

in case of emergency name and phone number to contact

Do you use eye products or had eyes surgery?

eyes surgery history, eyes medication, contact lens, makeup

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 I NEED TO ARRIVE WITH NO MAKEUP, CLEAN EYELASHES AND AVOID CAFFEINE AT LEAST 4 HOURS BEFORE THE APPOINTMENT.

I UNDERSTAND THAT THE PROCESS MIGHT TAKE FROM 1.5- 3 HOURS.

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, ETC.

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

I AGREE THAT BY READING & SIGNING THIS CONSENT FORM, I RELEASE MOONLIGHT GLOW LAB OR CHLOE DUONG 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 MOONLIGHT GLOW LAB OR CHLOE DUONG PERMISSION TO SHOW MY BEFORE & AFTER PHOTOS OF EYELASH EXTENSIONS TO OTHER POTENTIAL CLIENTS AND ON SOCIAL MEDIA.

I AM AWARE OF 2 CATS ONSITE AT MOONLIGHT GLOW LAB AND CONFIRM THAT I AM NOT ALLERGIC TO CATS.

I AM AWARE THAT THERE IS NO WASHROOM ONSITE DUE TO HOME BASED STUDIO.

I AGREE THAT NO ADDITIONAL GUESTS, FAMILY MEMBERS, FRIENDS, OR PETS ALLOWED.

I AGREE THE NO REFUNDS POLICY AND 72-HOUR COMPLIMENTARY REMOVAL OR CORRECTIONS IF I AM NOT SATISFIED WITH THE RESULTS.

I AGREE THAT THE $20 DEPOSIT IS NON-REFUNDABLE AND 20 MINUTES LATE IS AUTOMATIC CANCELLATION AND LOSS OF THE DEPOSIT.

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 MOONLIGHT GLOW LAB AND CHLOE DUONG TO APPLY EYELASH EXTENSIONS.

Signature

Date