Lash Lift/ Brow Lamination Consent Form

Lash Lift/ Brow Lamination Consent Form
Client Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about us?blank*
Are you presently taking any medications?*

YesNo
Please list*
Do you have any allergies to cosmetics, food, drug, or adhesive?*

YesNo
Please specify
Please Check Any Lash Lift Contradictions You May Have

Dry Eye SyndromeChemotherapySensitive EyesHistory of Eye InfectionsOcular RosaceaSjorgen’s Syndrome
Please Check Any Brow Lamination Contradictions You May Have

AlopeciaChemotherapyEczemaPsoriasisSuper Sensitive SkinSunburnWounds in Treatment AreaRecent Facial TreatmentRetinol, AHA, BHA, etc.
Please list any skin care treatments/facial products you use if applicable
Please Initial Each Statement
Initial*  I agree to have an eyelash lift, brow lamination and/or eyelash tint applied to my natural eyelashes/eyebrows and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm, brow lamination or eyelash tint by my technician.
Initial*  I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.
Initial *   I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.
Initial*   I understand that even though my technician perms the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/brows or require a physician's follow-up care.
Initial*   I understand that some mild but normal symptoms may occur with the brow lamination depending on the sensitivity of my skin during the procedure and will subside in 24 hours.
These symproms may include: mild tingling, slight redness due to brushing the hairs, slight warmth in the area.
Initial*   I understand that this agreement will remain in effect for this procedure and all future conducted by my technician.
Initial*   I understand I have the opportunity to request a patch test of the products being used. I accept full responsibility for any reaction which might occur due to undisclosed m sensitivities/allergies.
Initial*   I understand and consent to having my eyes closed throughout the procedure.
Initial *   I understand that if I have any concerns, I will address these with my lash/brow technician.
Initial*   I will remove any contact lenses during the procedure.
Please note that lash lifts and brow laminations can have certain side effects such as skin removal, redness, swelling, tenderness, etc.

I have read the above information and have given accurate account of the questions and if I have any concerns, I will address these with my technician. I give permission to my technician to perform the lash and/or brow service we have discussed and will hold her harmless from any liability that may result from this treatment. I agree to adhere to all safety post care including: no peels, tanning, or wet room activity; no swimming/spas/hot tubs for 24 hours after our appointment; and all home skin care protocals recommended by my service provider.

I understand that my technician will take every precaution to minimize or eliminate negative reactions as much as possible.
No Refund Policy

Thank you for choosing Magnify Lashes & Beauty! Please be aware that we do not offer refunds of any kind. If there is an issue with your lash set, please let your service provider know at the time of service or contact us within 24 hours of your appointment. We are happy to address any concerns and make necessary adjustments within that timeframe.Any concerns raised after 24 hours may require a new appointment and will be subject to standard service charges.Thank you for your understanding and continued support!
Client Signature*
Date*

MonthDayYear
Date
Should be Empty:

Lash Lift/ Brow Lamination Consent Form

No Refund Policy