LASH EXTENSIONS CONSENT & LIABILITY FORM
WELCOME TO NHU BEAUTY
Thank you for booking with me and please fill out this form prior to your appointment to ensure safe application of lash extensions!
FULL NAME
first
last
BIRTHDAY
-
Month
-
Day
Year
PHONE NUMBER
Format: (000) 000-0000.
EMAIL
example@example.com
INSTAGRAM USER
how did you hear about me?
instagram
other
tiktok
friend/referral
if referral/other, please list who/how:
is this your first time getting lash extensions?
yes
no
do you wear glasses?
yes
no
do you wear contact lenses?
yes
no
If you wear contact lenses, the glue used to apply eyelash extensions may get underneath the contact lenses and cause abrasion/scratching, redness, irritation, and/or dryness. Contact lenses are recommended to be removed prior to the service.
I understand and acknowledge the risk of wearing my contacts during the eyelash extensions service and that the lash artist, NIKKI-NHU DOAN, will not be responsible for any issues
NO refunds under any circumstances (cost of products, work, and time), free removal of extensions within 24 hours after appointment if unsatisfactory
I understand and agree there is no refund
POSSIBLE CONTRAINDICATIONS FOR THE SERVICE, if any apply to you, you will be refused service. Please message me for more details.
stye
eye infection/inflammation
eye injury
uncured permanent makeup (eye/eyebrow area)
laser eye surgery (past three months)
chemotherapy (ongoing or in past 12 months)
herpes
lichen ring
epilepsy
severe asthma
claustrophobia
cataract
glaucoma
dry eye syndrome
eczema around eye area
skin hypersensitivity
alopecia
trichotillomania
allergy to adhesives, cyanoacrylate, formaldehyde, carbon black
previous allergic reaction to eyelash extensions
none of the above apply to me
Some factors may affect lash retention and growth rates, please select what applies to you
use of medicines that cause hair loss
use of lash growth serums during the past month
lash lift treatments in the past six weeks
use of hormonal contraceptives
use of antibiotics
stress
hormonal disbalance
thyroid problems
pregnancy/breastfeeding
acidosis
none of the above apply to me
I agree and am aware that an allergic reaction may occur and Nikki-Nhu Doan (nhubeauty.ca) is not responsible. Allergic reaction symptoms include, but are not limited to swollen eyes, dry or itchy eyelids. If an allergic reaction occurs, it is recommended to seek a healthcare professional.
I understand
By signing this I confirm that the information given in this form is true, complete, and accurate. Please print name to sign.
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