Eyelash Extension Client Liability Waiver
MTHLASHES
Please Read Below
Every client is subject to filling out a consent form PRIOR to receiving any services from MTHLASHES and its Lash Technicians.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about MTHLASHES?
*
Google, Instagram/Facebook, Referral, etc
Have you had individual Eyelash Extensions before?
*
Please Select
Yes
No
Individual Eyelash Extensions meaning 1:1 placement, not similar to clusters.
Do you wear Glasses and/or Contacts?
*
Please Select
Glasses
Contacts
Both
Neither
If you wear contacts, please be advised clients are instructed to remove contacts prior to servicing. Please be sure to bring a contact case + solution to your service (if applicable).
What position do you most frequently sleep in?
*
Please Select
Left
Right
Back
Stomach
Please note your sleeping position can have an effect on your lash extension retention
If yes, have you ever had any reactions to Eyelash Extensions?
*
Example watery eyes, redness, allergies, etc
Do you suffer from any medical conditions? If so, please list them below.
*
Examples include, pregnancy, any former eye surgeries, etc
Are you currently on any medication?
*
Please note in the event medications are added or removed, please alert your lash artist
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Eyelash Styling Questionaire
Please answer the following below to better help your Lash Artist understand your styling goals. All answers on this form will be discussed during your consultation prior to service.
Desired Style
Please Select
Classic
Hybrid
Volume
Not Sure
Please select your desired service.
File Upload
Browse Files
Drag and drop files here
Choose a file
Please feel free to upload any “Inspo Pics” you may have.
Cancel
of
What does your Everyday Makeup Routine look like?
For example, mascara, strip lashes, winged eyeliner, etc
What are your Styling Goals?
Natural
Dramatic
Everyday Look
Wispy/Textured
Below give a brief description on your history with Eyelash Extensions (if applicable)
For example, how long you’ve been getting them, previous styling, likes/dislikes, experiences. This info helps your stylist customize your service to your needs as a client.
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I understand, and 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 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 PREMATURELY.
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 AND MTHLASHES FROM ALL LIABILITY ASSOSIATED WITH THIS PROCEDURE. THERE ARE NO GUARANTEES FOR THE BONDING TIME LENGTH OF THE EYELASH EXTENSIONS. MTHLASHES IS NOT RESPONSIBLE FOR ANY TECHNICIAN ERRORS. I UNDERSTAND THAT THERE ARE NO REFUNDS ON COMPLETED SERVICES.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
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