Eyelash extension client consent form
full name
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Name
Last name
Date of Birth
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Month
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Day
Year
Date
Age
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Cell phone number
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Format: (000) 000-0000.
Email
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example@example.com
I grant permission to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I release my lash technician and Beauty x Evan from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decided if I am a good candidate for this serive to the best of their ability.
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Initial
I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 to 3 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.
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Initial
I acknowledge BeautyxEvan does their full effort to fulfill my appointments times and I respectfully acknowledge the times I schedule to be available. I understand the following set CANCELLATION policies that are also non-refundable agreements of service. If you cancel or reschedule 24 hrs before your appointment, a 40% fee will be accessed upon cancellation. Second cancellation offense, you will be charged the full appointment amount. If you cancel often you will be no longer able to book with BeautyxEvan. While things may happen, we advise appropriately booking.
Initial
Is this your first time having Eyelash Extensions?
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Yes
No
Do you wear Contacts?
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Yes
No
Do you have ANY make up around your eyes today?
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Yes
No
Do you often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have , or are you being treated for any eye illness or injury?
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Yes
No
Are you able to lay on your back for 2-3 hours to have your lashes applied?
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Yes
No
Are you pregnant?
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Yes
No
What other products do you currently use around your eyes? (eye creams, oinments, lash growers, etc).
PLEASE NOTE USE OF OIL BASED PRODUCTS AROUND EYES SHOULD BE DISCONTINUED FOR 48 HOURS AFTER YOUR EYELASH EXTENSION SERVICE. It is also recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras, and liners will loosen the adhesive and your lashes will not last long.
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Please initial and date you read and understand the above.
For longevity we recommend not to use mascara, however if you must, be sure it is oil free and remove it daily with an oil free wash. We recommend our eye wash, or you may use Sterild or Occusoft (available at most drug stores).
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Please initial and date you read and understand the above.
Do you use lash growers such as Lattice or over the counter ones? It is best to discontinue use of these 2 weeks before you service and discontinue use while you are wearing your lash extensions. Some contain oils and/or steriods and will shorten the duration of your extensions.
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Yes
No
How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly.
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Side
Stomach
Back
The following conditions are not suitable for eyelash extensions.
Have you had Chemotherapy Treatments in the last 6 months? Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service.
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Yes
No
Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.
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Yes
No
Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (gel pads, glues, etc.)
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Yes
No
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid Conditions may not last long due to either of these.
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Yes
No
Blephoroplasty or other eye condition or surgery in the last 6 months? Blephoroplasty , eye surgery or conditions may have sensitivity to eyelash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service.
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Yes
No
Do you wear Contact Lenses:Contact Lenses MUST be removed prior to eyelash extensions procedures. Products may get underneath the contact lens and cause an abrasion or scratching.
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Yes
No
Do you have Extremely OIly skin and/or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, merely it may cause them to fall out quicker.
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Yes
No
I agree and understand that Beauty x Evan & my Lash Technician have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. Beauty x Evan does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
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Initial
Sign date
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Month
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Day
Year
Date
Client signature
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Type a question
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By signing below, I verify that I have read and understand the above statemetns and agree to them. Thank you for the time you took to read, understand and agree to our consent form..
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