LUMON

Full Name*

Suburb Post Code*

Phone*

Email*

example@example.com

Date of Birth*

Date

How did you hear about us*

Have you had lash extensions, lash or brow tinting, brow henna, or lash perming (also known as lash lift) previously?*

YesNo

If YES please provide information

Which length do you prefer?*

ShortMediumLong

Which style do you prefer?*

Cat EyeDoll Eye/ Open EyeNatural

How thick do you want your lashes to be?*

NaturalThickVery Thick

Have you ever had any previous issues or allergies with eyelash extensions in the past

Please check any of the following that may apply to you

Permanent eye make up in the last 3 monthsEye surgery in the last 4 monthsDry or sensitive eyesHay fever or seasonal allergiesUse of retinoids for skin treatment such as accutane or retin AOther

Are you taking any medications at the moment

LIABILITY WAIVER AND CONSENT FORM

I agree to the following:

Having artificial eyelashes applied to and/or removed from my natural eyelashes
Having tint applied to my eyelashes and/or eyebrows
Having eyelash lift (perm) and/or tint applied to my natural eyelashes
Having eyebrow wax, trimmed, tweezed, and/or brow tint/henna/brow dye applied

I understand that the procedure/s may be performed by a qualified professional technician or a trainee. Before my technician can perform the procedure/s, I understand I must complete this agreement and provide my consent by signing and dating where indicated below.

Waiver of liability

I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, having tint applied to my eyelashes and/or eyebrows, or having eyelash lift (perm That notwithstanding the utmost of care in the application or removal of these products, there are still_risks associated with the procedure and the product itself, which include, without limitation, eye irritation, eye pain, discomfort, and, in rare cases, an eye infection or blurriness when improperly handled. If I experience any irritation, redness, puffiness, itchiness, an allergic reaction, or any side effect of the procedure, I will contact my technician and medical professional immediately.

Permission to use still and/or moving images

I hereby grant my service provider the full right to take, publish, and reproduce still and/or moving images of me, my eyes and/or my eyelashes and brows, both before and after the procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary.

Care and maintenance

I agree to follow the care and maintenance instructions provided by my technician, and that 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 not follow the after-care instructions, it may result in damage of my eyelash extensions or may cause my lashes to fall off prematurely. Knowing this I agree to follow the after-care tips for best result.

No known medical conditions / informed consent

I have read and completed this form in its entirety and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects that the lash procedure or removal may cause. I understand that the procedure requires that I lay still for the duration of the procedure with my eyes shut. 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 the instructions or these warnings.

Lash warranty

I understand that LUMON BEAUTY offers a 72 hours guarantee policy. I will contact my technician within 3 days to discuss any arising issues or concerns regarding the result. I understand that any repair or touch-up appointment must be made within 7 days of the initial appointment. Any appointments made later than 7 days from the original appointment will incur a normal service price due to overexposure to everyday wear and tear. LUMON BEAUTY express their professional recommendations of the most appropriate style for my personal features. I understand the risk of choosing other than the recommended styles and that lash warranty will be void. Lash warranty is automatically voided for refills done from another beauty salon. Please note no refunds will be given under any circumstances.

This agreement will remain in effect for this procedure and all future procedures. I understand it is my responsibility to advise my technician of any changes in the future that may affect my suitability for procedures to be undertaken at any time in the future.

I agree that by reading and signing this from I release LUMON BEAUTY and its' representatives and technicians of all claims and injury, seen or unseen that may occur as a result of the procedure.

I understand that this agreement is binding and that I have read and fully understand all information listed above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

Signature*

Full Name*

Date*

Date

Parent/Guardian (if under 18 years old) Full Name :

Full Name

Date

Signature

CLIENT INFORMATION AND CONSENT FORM

LIABILITY WAIVER AND CONSENT FORM

Waiver of liability

Permission to use still and/or moving images

Care and maintenance

No known medical conditions / informed consent

Lash warranty