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Lash Extension Client Liability Waiver
I, undersigned, agree with the following statements:
I UNDERSTAND THAT THERE ARE RISKS ASSOCIATED WITH HAVING ARTIFICIAL EYELASHES APPLIED TO AND/OR REMOVED FROM MY NATURAL LASHES.
I UNDERSTAND THAT AS PART OF THE PROCEDURE, EYE IRRITATION, PAIN, ITCHING DISCOMFORT AND IN RARE CASES EYE INFECTION MAY OCCUR.
I UNDERSTAND AND AGREE THAT IF I EXPERIENCE ANY OF THESE ISSUES WITH MY LASHES I WILL CONTACT MY TECHNICIAN AND HAVE THE EYELASH EXTENSIONS REMOVED IMMEDIATELY AND CONSULT A PHYSICIAN AT MY OWN EXPENSE.
I UNDERSTAND THAT EVEN THOUGH THE TECHNICIAN MAY APPLY AND REMOVE THE EYELASH EXTENSIONS PROPERLY, THAT ADHESIVE MATERIAL MAY BECOME DISLODGED DURING OR AFTER THE PROCEDURE, WHICH MAY IRRITATE MY EYES OR REQUIRE FURTHER FOLLOW UP CARE.
I UNDERSTAND AND AGREE TO FOLLOW THE AFTERCARE INSTRUCTIONS PROVIDED BY MY TECHNICIAN. FAILURE TO FOLLOW THE AFTERCARE INSTRUCTIONS MAY CAUSE THE EYELASH EXTENSIONS TO FALL OUT.
I UNDERSTAND THAT IN ORDER TO HAVE THE EYELASH EXTENSIONS APPLIED TO MY EYELASHES I WILL NEED TO KEEP MY EYES CLOSED FOR DURATION OF 60-180 MINUTES DURING THE PROCEDURE. I ALSO UNDERSTAND THAT I WILL NEED TO BE LYING IN A RECLINED POSITION. ANY MEDICAL CONDITIONS THAT MIGHT BE AGGRAVATED BY LYING STILL FOR A PROLONGED PERIOD OF TIME MAY MEAN THAT I WILL NOT BE ABLE TO HAVE THE PROCEDURE PERFORMED ON MY EYES.
THIS AGREEMENT WILL REMAIN IN EFFECT FOR THIS PROCEDURE AND ALL FUTURE PROCEDURES CONDUCTED BY MY TECHNICIAN. I UNDERSTAND THAT THIS AGREEMENT IS BINDING AND THAT I HAVE READ AND FULLY UNDERSTAND ALL INFORMATION ABOVE.
I RELEASE MY TECHNICIAN BEEESLASHES FROM ALL LIABILITY ASSOSIATED WITH THIS PROCEDURE. THERE ARE NO GUARANTEES FOR THE BONDING TIME LENGTH OF THE EYELASH EXTENSIONS. BEEESLASHES IS NOT RESPONSIBLE FOR ANY TECHNICIAN ERRORS. I UNDERSTAND THAT I HAVE BEEN ADVISED TO FOLLOW THE AFTERCARE PROTOCOL FROM MY TECHNICIAN SO AS TO AVOID ANY DISCOMFORT OR ADVERSE SIDE EFFECTS AFTER THE PROCEDURE HAS BEEN COMPLETED.
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Health History: Please check any of the following that applies to you.
Allergy to adhesives, band aid, or medical tape?
Seasonal Allergies?
Allergy to glycerin?
Eye Illness or Injury?
Blepharitis (Inflamated Eyelids)
Do you currently have permanent Eye Makeup? (tattooed eyeliner)
Do you have an eye lift?
Are you taking any medications that may cause temporary hair loss?
Have you had a major surgery within the last 120 days/ 3 months?
Not applicable
Have you ever had eyelash extensions before?
No
Yes
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