LashDesignHER Waiver & Consent Form

LashDesignHER Waiver & Consent Form

The purpose of this waiver and consent form is to inform you about the eyelash extension procedure and its associated risks, although we take every precaution and ensure safety. By signing, you acknowledge that you understand the application process, potential side effects such as allergic reactions or eye irritation, and the importance of aftercare. You agree to adhere to aftercare instructions provided by the technician. Signing also confirms your consent to undergo the procedure and releases the establishment from liability associated with any complications, provided standard practices are followed. Please ask any questions before signing to ensure clarity and understanding.
Full Name*

Name Last name
Date of Birth (We have Birthday coupons)

MonthDayYear
Date
Age *
Cell Number*

Area CodePhone Number
Email*
example@example.com
Are you under the influence of any alcohol or drugs?*

YesNo
Is this your first time having Eyelash Extensions?*

YesNo
Why are you applying lash extensions today?*

Special occasionDaily wear
Do you wear Contacts?*

YesNo
Do you have ANY make up around your eyes today?*

YesNo
Do you often rub, pull or pick your lashes for any reason?*

YesNo
Do you currently have, or are you receiving treatment for any eye illness or injury?*

YesNo
Please provide details of any eye drops or eye medications you are currently using.
Are you able to lay on your back for 2 hours to have your lashes applied?*

YesNo
Will you be able to keep your eyes completely closed for up to 2 hours?*

YesNo
Are you pregnant?*

YesNo
What other products are you currently using around your eyes? This includes items like eye creams, ointments, lash growth serums, etc.
Please be aware that the use of oil-based products around your eyes should be avoided for 48 hours following your eyelash extension service. Additionally, it is recommended to refrain from using oil-based products, waterproof mascaras, and liners for the duration of wearing your lashes, as these can weaken the adhesive and reduce the longevity of your extensions.*
Please initial and date you read and understand the above.
For longer-lasting results, we advise against using mascara (your lashes will already look glamorous without it). If you must use mascara, ensure it is oil-free and remove it daily using an oil-free cleanser. We recommend our own eye wash, or you can use products like Sterild or Occusoft, available at most drug stores.*
Please initial and date you read and understand the above.
Are you currently using lash growth products like Latisse or over-the-counter alternatives? It's important to stop using these two weeks before your service and refrain from using them while you have your lash extensions. Some of these products contain oils or steroids, which can shorten the lifespan of your extensions.*

YesNo
How do you typically sleep? Please be aware that you may experience more eyelash extension loss on the side you sleep on. Sleeping on your stomach can have the most impact on them. It's crucial to avoid sleeping on your stomach for the first 2 days after your service to ensure the adhesive sets properly.*

SideStomachBack
Below are conditions that are not suitable for eyelash extensions. Potential adverse reactions are listed for each condition.
Do you have any allergies to adhesives (glues, tapes, band-aids, etc.)? This service involves the use of adhesive tapes, glues, and gel pads that could potentially cause an allergic reaction. While we use a medical-grade, formaldehyde-free glue, allergies can still occur.*

YesNo
Have you undergone chemotherapy treatments in the last 6 months? Medications used during chemotherapy may react with the materials used in this service. Additionally, if your lashes are just beginning to grow back, they may be fragile. We recommend waiting until they are strong enough before proceeding with this service.*

YesNo
Have you undergone Lasik surgery in the past 4 months? Your eyes may be sensitive to eyelash extensions and the products used for preparing the eye area (such as gel pads and glues).*

YesNo
Are you currently taking thyroid medications? Please note that thyroid medications or thyroid conditions may affect the longevity of your eyelash extensions.*

YesNo
Have you undergone blepharoplasty or any other eye surgery or experienced eye conditions in the last 6 months? These factors may result in sensitivity to eyelash extensions and the products used during the service. We recommend consulting your doctor to ensure it is safe for you to proceed with this service.*

YesNo
Do you wear contact lenses? Contact lenses must be removed before eyelash extension procedures. Products may get underneath the contact lens, potentially causing abrasion or scratching.*

YesNo
Do you have extremely oily skin and/or hair? Natural oils can break down the adhesives used to bond eyelash extensions, which may cause them to fall out more quickly. This does not necessarily prevent you from having the service, but it may affect the longevity of the extensions.*

YesNo
Beautiful lashes can truly elevate your confidence! We exclusively utilize high-quality medical-grade glue and soft, lightweight lashes to achieve a glamorous yet natural appearance. Here’s what you can expect during your session today:
Step 1 - Consultation with your Lash Extension Expert to ensure this service is suitable for you, and to thoroughly explain your experience before, during, and after.

Step 2 - Choose your preferred lash style to enhance length, fullness, and shape. If unsure, your lash technician will gladly recommend the best option for your lifestyle.

Step 3 - Enjoy your lash session!

Step 4 - Schedule your refill appointment in approximately 2 1/2 to 4 weeks.

Just a few more details to ensure you receive exceptional service and results.
I acknowledge that eyelash extensions require regular maintenance, similar to nail services. Refills are recommended approximately every 2 to 3 weeks. I understand that exceeding this recommended timeframe may require a full set or incur a higher "relash" price.*
Initial
I acknowledge and understand that the studio does not offer refunds. The lash technician will do their utmost to ensure customer satisfaction.*
Initial
I agree to seek medical care at my own expense and promptly contact my technician if I experience any allergic or adverse reactions. I confirm that all my questions have been addressed, and I understand both the procedure and associated risks.*
Initial
I acknowledge and understand that the lash technician cannot determine if the client is allergic to any of the products or materials used during the procedure.*
Initial
I authorize the use of my before and after photos for marketing purposes or as examples of my technician's work.*

YesNo
I release my certified lash technician and Lash DesignHER from any and all liability associated with this procedure. The service will be conducted with strict adherence to safety, sanitation, and proper application using tools and products that the technician is trained and certified to use. Factors such as lifestyle, humidity, weather, extreme temperatures, natural eyelash shedding, and others contribute to the variability of this service. The technician, in conjunction with my consent form and consultation, will determine to the best of their ability if I am a suitable candidate for this service.*
Initial
Agree to Terms & Conditions*

By signing below, I confirm that I have read, understood, and agree to the above statements. Thank you for taking the time to review, comprehend, and consent to our form.
Signed Date *

MonthDayYear
Date
Client Signature *

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LashDesignHER Waiver & Consent Form

Below are conditions that are not suitable for eyelash extensions. Potential adverse reactions are listed for each condition.

Beautiful lashes can truly elevate your confidence! We exclusively utilize high-quality medical-grade glue and soft, lightweight lashes to achieve a glamorous yet natural appearance. Here’s what you can expect during your session today: