Lash Lift & Lash Tint Form

Although every precaution will be taken to ensure your safety and well-being before, during, and after your lash lift and/or lash tint, please be aware of the following information and possible risks.

• I understand that there are risks associated with having an eyelash lift.
• I understand that as part of the eyelash lift procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blurriness could occur.
• I agree that if I experience any of these conditions with my eyelashes or eyes, that I will contact my esthetician; if I choose to consult a physician, it will be at my own expense.
• I understand that the instruments, tapes, cleaners, eye gel pads, adhesives, and/or removers may irritate my eyes or require a physician’s follow-up care, even though my esthetician utilized correct techniques and followed proper safety protocols.
• I understand that an eyelash lift will lift my natural eyelashes. Depending on my natural eyelash length and strength, results may vary.
• I understand and agree to the care instructions provided by my esthetician for the use and care of my eyelashes after the eyelash lift. I realize and accept that the consequences of failure to adhere to these instructions may cause the eyelashes to not stay as lifted as long as originally told.
• I understand and consent to having my eyes closed and covered for the entire duration of the procedure.

I agree to the following lash lift care and maintenance instructions:
No water can come in contact with the eye area for 24 hours after the applications.

This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician.

I have read the above information. If I have any concerns, I will address these with my esthetician. I give permission to my esthetician to perform the eyelash lifting procedure we have discussed and will hold her and her business harmless from any liability that may result from this treatment.

I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

In the event I may have additional questions or concerns regarding my treatment, I will consult my esthetician immediately.

I agree that this constitutes full disclosure, and that it supersedes any previous
verbal or written disclosures.

I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.

I do not hold the esthetician, Ignacia Owen, responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed today.

We would like your permission to use your photo for advertising and or social media. Your consent is necessary to do so.

I herby give my permission

A: to use, re-use, publish any photographic portraits or pictures of me.

B: I relinquish any right that I may have to examine or approve the completed product or products advertising copy or printed matter that may be used in conjunction therewith or the use to which it may be applied.

C: I hereby affirm that I am over the age of 18 and have the right to contract in my own name. I have read the above authorization, release and agreement, prior to this execution; I fully understand the contents thereof.

This agreement shall be binding upon me and my heirs, legal representatives and assigns.