TheeLashEnthusiast Lash Consent Form

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

Christie123@example.com

Contact in case of Emergency

If so, specify any reactions or sensitivities*

Do you have any allergens? If so, specify:*

Are you pregnant ? *

Do you use contacts or any eye products ? *

CONSENT

I UNDERSTAND THAT THIS PROCEDURE REQUIRES SINGLE SYNTHETIC LASH HAIR TO BE GLUED TO MY OWN NATURAL EYELASHES.

I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO KEEP MY EYES CLOSED & BE STILL DURING THE ENTIRE PROCEDURE, UNTIL MY EYELASH TECHNICIAN ADDRESSES ME TO OPEN MY EYES.

I UNDERSTAND THAT SOME RISKS OF THIS PROCEDURE MAY BE BUT NOT LIMITED TO EYE REDNESS & IRRITATION. THE FUMES FROM THE ADHESIVE MAY CAUSE MY EYES TO TEAR UP IF I
OPEN MY EYES.

I AGREE TO DISCLOSE ANY ALLERGIES THAT I MAY HAVE TO LATEX, SURGICAL TAPES, CYANOACRYLATE, VASELINE, ECT.

I UNDERSTAND THAT I AM REQUIRED TO FOLLOW THE EYELASH EXTENSION CARE INFO IN ORDER TO MAINTAIN THE LIFE OF THESE EXTENSIONS.

I AGREE THAT BY READING & SIGNING THIS CONSENT FORM, I RELEASE CHRISTIE LEFEVRE FROM ANY CLAIMS OR DAMAGES OF ANY NATURE.

I AGREE THAT I READ & FULLY UNDERSTAND THIS ENTIRE CONSENT FORM.

I AM OF SOUND MIND & FULLY CAPABLE OF EXECUTING THIS WAIVER FOR MYSELF.

I GIVE CHRISTIE LEFEVRE PERMISSION TO SHOW MY BEFORE & AFTER PHOTOS OF EYELASH EXTENSIONS TO OTHER POTENTIAL CLIENTS.

I HAVE READ & COMPLETED THE EYELASH EXTENSION INTAKE & CONSENT FORM IN ITS ENTIRETY, & HAVE ANSWERED EVERYTHING TO THE BEST OF MY ABILITY. I HAVE BEEN INFORMED OF POTENTIALLY HARMFUL OR NEGATIVE SIDE EFFECTS THAT MAY BE CAUSED BY THE APPLICATION AND/OR REMOVAL OF EYELASH EXTENSIONS.

I CONFIRM & AGREE THAT I WISH TO ENGAGE THE SERVICES OF CHRISTIE LEFEVRE TO APPLY EYELASH EXTENSIONS.

Signature*

Client Signature