Language
English (US)
Español
Lash Lift / Brow Lamination
2024
1. I agree to have a Lash Lift solution and Lash Tint applied to my natural eyelashes and/or Brow lamination solution to my eyebrows. Initial below:
2. I understand there are risks associated with having a Lash Lift and/or Lash 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. Initial Below:
3. I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense. Initial Below:
4. I understand that even though my technician performed the technique properly, the instruments, tapes, cleaners, eye gel pads, adhesives and removers used may irritate my eyes or require a physician's follow-up care. Initial Below:
5. I understand and agree to the aftercare instructions provided by my technician for the use and care of my Lash Lifted and /or Tinted. No water can come in contact with the eye area until the specified time given by my technician, 24 hours after application. I will do my part to maintain my Lash Lift. Initial Below:
6. I realize and accept the consequences of failure to adhere to these aftercare instructions may cause the eyelashes to not stay lifted as long as told. I understand and consent to having my eyes closed and covered for the duration of the procedure. Initial Below:
7. I am informing my technician of the following conditions by marking with a check: •Current use of contact lenses which I agree to remove during application. •Current use of anything such as oil-containing sunscreen or moisturizers around the eyes. •Current use of eye drops of any kind, prescription or over wise •Current allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives and removers that could cause my eyes to water and blink in excess. •History of recurrent eye or tear duct infections. •History of dry eyes or Sjorgen's Syndrome. •History of Chemotherapy. •Recent facial procedures Please Initial and list any Other medical conditions which would prohibit or compromise the process and retention of Lash Lift below:
Please INITIAL AND LIST CONDITIONS
8. I understand that this agreement will remain in effect for this procedure and all future procedures conducted by my technician. Initial Below:
9. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. Initial Below:
10. I understand this form to its entirety and have listed any possible contraindications. I authorize LASH OUT BY ALY DEE to perform the lash lift & tint and/or Brow Lamination. Initial Below:
I agree to all terms on this form:
Enter Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Signature
Continue
Continue
Should be Empty: