Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
Instagram
Friend
Other
Health History | Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you ever had eyelashes extensions before?
Yes
No
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.
I understand and agree that if I experience any issues with my lashes I will contact my technician and have the eye lash extensions removed immediately and consult a physician at my own expense.
I understand that in order to have the eyelash extensions applied to my eyelashes, I will need to keep my eyes closed for a duration of 60 to 80 minutes during the procedure.
I understand that AngelicEsthetics does not issue refunds, but would gladly fix the lash extensions after 1 to 4 days if excessive unexpected fallout happens. Any excess fallout after the fifth day would result in a one week fill which you would then be charged a fee.
I understand that this consent form remains in affect for all future appointments.
Date
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Month
 -
Day
Year
Date
Client Signature
Please message me if you have ANY questions/concerns. Thank you for choosing me as your artist!🪽
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