Lash Lift & Tint Consent
I am informing my technician of any of the following contraindicated conditions.
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Allergies to adhesive tape, fumes, eye remover, Hydrogen Peroxide or
Dry Eye Syndrome
Sjorgen's Syndrome
Currently having Chemotherapy
Ocular Rosacea
None of the above
I consent to having my eyes closed and covered for the duration of the 45-60 minute procedure.
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Yes
No
I wear contacts
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Yes, please come without contacts to avoid getting lashes wet when you have to remove them !
No
Do you use a lash serum?
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If yes, stop temporarily 24-48 hrs prior to appointment!
No
Are you pregnant ?
If yes, we will have to wait till you are given the clear from your doctor
No
Do you have claustrophobia?
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Yes (text me so we can talk)
No I do not !
I, undersigned, accept the following statements:
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I agree to have an eyelash lift (perm) and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm or eyelash tint by my esthetician (Brandon).
I understand there are risks associated with having an eyelash perm and/or eyelash 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 agree that if I experience any of these medical conditions with my lashes that I will contact my esthetician (Brandon) and consult a physician at my own expense.
I understand that even though my Esthetician (Brandon) 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 Esthetician (Brandon) 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 eyelashes to not stay permed as long as told.
I agree as post-lash lift that no water can come in contact with the eye area for 48 hours after the application and I avoid getting wet or using oil products such as sunscreens, moisturizers and cleansers of on lashes.
I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician (Brandon). I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my Esthetician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products and sanitation that the Esthetician has been professionally trained to use. There are no guarantees for 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 eyelash 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.
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date
Signature
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Before Appointment Things
Please Come to appointment with clean lashes and no makeup to avoid removal at appointment
Submit
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