• Lash Lift and Brow Lamination Consent Form

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • How did you hear about us?

  • Health History

  • What service are you looking to have done?*
  • Have you had an eyelash lift in the past?*
  • Have you ever had a brow lamination in the past?*
  • Have you ever used hair color/eyelash tint?*
  • Have you ever had an allergic reaction to hair color/eyelash tint?*
  • Do you wear contact lenses?*
  • Are you currently using eye drops of any kind, prescription or over-the-counter?*
  • Do you have a history of recurrent eye or tear duct infections?*
  • Do you have a history of dry eyes or Sjorgen’s Syndrome?*
  • I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.*

  • I acknowledge that I must adhere to the policies. I understand all services require a non-refundable deposit of $20. The deposit will be credited towards my appointment. I agree to arrive 10 minutes prior to my appointment. 


    I understand that cancellations or rescheduling an appointment must be done with at least 24 hours notice. Failure to attend without prior notice will require a deposit fee to secure my next appointment. I understand that after 15 minutes of tardiness, my appointment may be subject to cancellation, and I will be responsible in accordance with the “No-show” policy. Tardiness may also result in shortened service time and full service charge.

     

    Risks: I understand that there are risks associated with having an eyelash or brow lamination, including potential eye or skin irritation, discomfort, and in rare cases, infection.


    Contact and Follow-up: I agree that if I experience any of these conditions with my eyelashes, brows, or eyes, I will contact my technician. If I choose to consult a physician, it will be at my own expense.


    Instrument and Product Risks: I understand that the instruments, tapes, cleaners, eye gel pads, adhesives, and/or removers may irritate my eyes or skin or require follow-up care, even though my technician utilized correct techniques and followed proper safety protocols.


    Results Variation: I understand that an eyelash or brow lamination will enhance the appearance of my natural eyelashes or brows, and that results may vary based on my natural hair length and strength.


    Aftercare Instructions: I agree to follow the provided aftercare instructions to maintain the results of the eyelash or brow lamination.
    Procedure Consent: I understand and consent to having my eyes closed and covered for the entire duration of the procedure.


    Care Instructions: I agree to avoid water contact with the eye or brow area for 24 hours after the application.

    Liability Release: I give permission to my technician, Emilia Figueroa, to perform the eyelash lift or brow lamination procedure we have discussed, and I hold her and/or Em Beauty & Skin LLC harmless from any liability that may result from this treatment.


    Full Disclosure: I certify that I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand the procedure and accept the risks.

    I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. 

    This agreement will remain in effect for this procedure and all future procedures conducted by my technician.

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