Form

Lashesbyrosiii

Eyelash Extension Intake/Consent Form
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please inform me on what comfort of level you want during your session, do you prefer music, a show to hear throughout , podcasts or silent session.
I Grant permission for Lashesbyrosiii to use my photos for marketing or examples of my lash techs work.
I release Lashesbyrosiii 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. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding, and other factors. I will sign this giving all my consent to get my Eyelash Extensions done by someone who is not certified and I I am also giving consent that what ever happens after the appointment is not the lash techs fault nor responsibility .
Initial
Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 to 3 weeks. I understand if I go beyond this recommended time it may result to and incur (higher) service cost as a full-set.
Initial
Is this your first time having Eye-lash Extensions?
What are you getting lash extensions applied for?
Do you often rub, pull or pick your lashes for any reason?
Do you have a servers eye illness or are you being treated for an eye injury/infection?
How do you usually sleep? Please notice , you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most. It is important to refrain from sleeping on your stomach for the first 2 days after your serve to allow the adhesive to set properly.
Are you able to lay on your back for 3-4 hours to have your lashes applied?
It is also recommended to avoid all oil-based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras, and liners will loosen the adhesive and your lashes will not last long. Let’s talk approved products during your appointment. Please come to your appointment with no eye-makeup.
Please initial if you read and understand the above
AFTER CARE GUIDELINES

- After your service keep your lashes try 6-10 hours.

- Avoid facemasks, and don't let shampoo or conditioners from coming in contact with your lashes.

- Avoid swimming, steam rooms, and saunas for 48 hours.

- Avoid rubbing your eyes.

- Do not use facial wipes, and oil or cream-based cleansers. Avoid cleansing waters that are moisturizing or with added emollients.

- Do not use eyelash curlers.

- Do not wear any mascara or gel eyeliners.

- Use water-based makeup remover.

- Brush your lashes everyday to keep them neat and tidy.

- Clean your lashes daily with a foaming lash cleanser to remove any facial oil, make-up residue and dirt.

- To maintain the fullness of your lashes, we recommend a refill every 2-3 weeks.
The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition.
Are you allergic to adhesive (glues, tapes, band aids, etc)? This service may use adhesive tapes, glues, and gel pads that may cause an allergic reaction.
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 be a little weak and we recommend waiting until they are strong enough for this service.
Have you had Lasik Surgery in the last 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area. (Gel pads, glues, etc)
Are you pregnant?
I agree and understand that Lashesbyrosiii ( my lash technician) have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reactions occur. All of my question were answered and I understand the procedure and risks.
Initial
Thank you for giving me the time to get to know YOU & signing the Consent Form, it’s much appreciated towards your lash experience!
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Lashesbyrosiii

The following conditions are not suitable for eyelash extensions. Possible adverse reactions are listed below each condition.