Eyelash Extension Consent Form

I INSERT NAME* agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. I consent to the placement and/or removal of the eyelash extensions by the licensed professional.

INITIAL* I understand that in rare occasions there are risks associated with having artificial eyelashes or eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation or discomfort could occur. I agree that if I experience any of these conditions with my lashes I will contact the licensed professional that performed this procedure and it may be beneficial to have the eyelashes removed.

INITIAL* I understand and agree to the after-care instructions provided by the licensed professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out and/or decrease the time the lashes will last.

INITIAL * I understand and consent to having my eyes closed and covered and laying on my back for the duration of approximately 60 - 120 minute procedure. Times may vary depending on the type and number of eyelashes applied.

INITIAL* I am honestly informing the licensed professional of the following conditions by marking with a check; if I mark any of the following that say "prohibit the placement of eyelash extensions" I will not book an eyelash appointment or cancel one that I have already made until the condition has been resolved and cleared by a medical professional.

Current use of contact lenses which I will remove before the procedureCurrent eye infection that will prohibit the placement of eyelash extensionsCurrently undergoing chemotherapy that will prohibit the placement of eyelash extensionsOther medical conditions which would prohibit the placement of eyelash extensions

INITIAL* I understand agree to the following eyelash extension follow-up and maintenance/after care instructions:

I will not use mascara, eyelash strips, or eyelash curlers.
I will not use oil based products around the eye area.
I will not tint or perm eyelash extensions.
I will not pull or rub eyelash extensions.
If any eye drops be necessary, I will take extra care to prevent moisture from coming into contact with lash extensions.
I will handle lashes gently, only brushing my lashes with a lash wand daily.
I will not sleep face down on my eyelash extensions.
I will cleanse lashes daily with lash shampoo that I will receive if I buy a lash kit from the licensed proffesional or buy lash shampoo from a retail store that carries product.
If lash extesnions turn due to growth of natural lash I will use lash wand to brush back in place.
I will ensure lashes are dry after getting wet.
I understand I naturally shed 2-5 lashes per day due to the natural growth cycle which requires a fill every 2-3 weeks. (1 week = approxiametly 21 lashes)

This agreement will remain in effect for this procedure and all future follow-ups conducted by the licensed professional. 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 am over 18 years of age and consent to the agreement and to the eyelash extension procedure.

Client Name*

First NameLast Name

Client Signature*

Licensed Professional Signature

EYELASH EXTENSION CONSENT FORM