Eyelash Extensions Client Information & Consent Form

Name

First NameLast Name

Email

example@example.com

Date

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Have you ever had eyelash extensions before?

Have you ever experienced an allergic reaction to eyelash extensions or lash adhesive? If yes, please describe the reaction, including symptoms and severity. If no, please write N/A

Do you have sensitive eyes?

DISCLAIMER & CONSENT

I understand that eyelash extension adhesives contain cyanoacrylate, which may cause irritation or allergic reactions in some individuals. Possible reactions may include, but are not limited to, redness, itching, swelling, or discomfort of the eyes or surrounding area.

I acknowledge that allergic reactions can occur even if I have not previously experienced a reaction. I confirm that I have disclosed any known allergies or sensitivities. I understand that if I have a history of reactions to eyelash extension adhesives or have highly sensitive eyes, I should not proceed with this service.

By signing below, I acknowledge that I have read and understand the above information and voluntarily consent to receive eyelash extension services.

I certify that I have read all the information above.

I understand that the deposit is non-refundable and non-transferable, and failure to show or cancel will result in forfeiture of the deposit.

I fully understand the risk associated with eyelash extensions.

I understand I am fully responsible for the maintenance of my eyelash extensions and will follow all aftercare instructions to protect the health of my natural lashes and the extensions

I understand it is my responsibility to keep my eyes closed and stay still during the entire application process.

I understand that the fumes from the adhesive may cause my eyes to water during the application process.

I understand that some of the risks involved with this procedure may be, but are not limited to eye redness, swelling, and/or irritation.

I, (Your full name here)* , understand and acknowledge that I voluntarily release and hold harmless Lashed By Day, its owner, and affiliates from any and all liability, claims, or damages, including but not limited to bodily injury, personal injury, or property damage, that may arise from the services provided.

I acknowledge that I have read and fully understand this agreement before signing.

Client’s Signature