Eyelash Extension Consultation & Consent Form

  • Eyelash Extension Consultation Form

  • Client Information

  • Date of Birth
     - -
  • Format: (000) 000-0000.

  • Emergency Contact
  • Format: (000) 000-0000.

  • Medical History

  • Do you have or have you had any of the following conditions? If yes, please select them:
  • Are you allergic to the following?
  • Do you wear glasses?
  • Do you were Contact Lenses?
  • Do you have, or are you being treated for any eye illness/injury?
  • Do you often have eye irritation, itching or watery eyes?

  • Eyelash History

  • Have you ever had eyelash extension before?

  • If yes:
  • Were they applied by a professional?
  • Do you use any of the following products on your eyelashes?
  • Do you do any of the following to your lashes:

  • By signing below, you agree to the following: I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any changes in the above information. I agree that I do not have any condition/s that would make the requested treatment unsuitable. I agree to waive all liabilities toward my technician and the employer for any injury or damages incurred due to any misrepresentation of my health.

  • Client Consent Form

  • I hereby consent to and authorize to perform the following procedure:
    Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.

  • Please check each statement:

  • This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. I understand my lash extension specialist will take every precaution to minimize or eliminate negative reactions as much as possible. I will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the lash extension specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today. 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 application procedure.
  • Should be Empty: