Eyelash Extension
  • Eyelash Extension

    Eyelash Extension

    Client Information Form
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  • Client Information

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  • Occasionally I may send out emails or newsletters about upcoming discounts, promotions, contests, company information etc. If you would like to be added to the subscriber list please check “Yes” below. If you would like to opt out please check “No”.

  • Do you wear glasses?
  • Do you have frequent eye irritation, itching, or watery eyes?
  • Have you had eye surgery in the last six months?
  • Eyelash extensions require medical tape and adhesives that may contain acrylic or latex.

  • Are you allergic to latex?
  • Are you allergic to acrylic?
  • PLEASE CHECK ANY OF THE FOLLOWING THAT MAY APPLY TO YOU:

  • RELATING TO THE EYE
  • Date
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  • Eyelash Extension

    Eyelash Extension

    Liability Waiver
  • Cancellation Policy

    Your appointment time is reserved just for you. A late cancellation or missed visit leaves a whole in my day that could have been filled by another client. As such, I require 24 hours notice for any cancellations or changes to your appointment. When you cancellation or change a day you can change another day but you deposit is Non Refundable.

    * Appointments canceled less than 24 hours before the appointment time will be cancellation.

    * No call no shows you appointment will be cancel and given to other person

  • Late Policy

    * Please let me know in advance if you are running late. If you are going to be less than 15 mins late I will still be able to accommodate you, it will just result in less time in the appointment. (example: Less time spent on lash extensions = not so full lashes).

    * More than 15mins late requires you to rebook an appointment and will result in you being cancellation of your appointment.

     

  • Care and Maintenance

    I agree to follow the care and maintenance instructions provided by the eyelash extension artist for the use and care of my eyelash extensions, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my eyelash extensions or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results:

     

    • I will avoid oil based eye products, as these will loosen the bond of my eyelash extensions.

    • If I experience any itching or irritation, I agree to contact a medical doctor immediately and the eyelash extension artist to have the eyelash extensions removed.

    • I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my eyelash extensions.

    • I agree to not pick, pull or rub my eyelash extensions.
    • I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my eyelash extensions be professionally removed.
    • I understand that if I pick, pull on, or rub my eyelash extensions it may result in the premature temporary and permanent loss of my mink and natural eyelashes.
  • Way of Payment

    I agree and understand that my depost is Non Refundable and I will send my depost two weeks in advance to hold my appiontment. I do agree that my depost is half of my payment for the day I will be recieveing my indivial lashes. I agree that I will pay the rest of my fee up front before my lash tech start my services. 

     

     

  • Permission to Use Photos

    I hereby grant the eyelash extension artist the full right to take, publish pictures of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, including the right to retouch these pictures as deemed necessary by the eyelash extension artist.  I further expressly assign any copyright in these pictures to the eyelash extension artist.  I also grant my consent for the eyelash extension artist to use my image and likeness as contained in these pictures for any advertising or other purposes.

  • No Known Medical Conditions / Informed Consent

    I have read and completed the Eyelash Extension Intake Form in its entirety and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelash) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate or formaldehyde, which in small amount may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2 hours or longer with my eyes shut, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the eyelash extension artist's instructions or these warnings.

  • Date
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