Lash Lift Consent Form
Thank you for choosing Simply Wonderful Nails. Please complete the following consent form prior to your appointment.
Name
*
First Name
Last Name
Phone Number
*
Email
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Health History | Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to cyanoacrylate
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
I consent my technician and Simply Wonderful Nails to take before and after pictures which may or may not be used for advertising purposes.
*
Yes
No
Please agree to the terms and conditions
*
I understand that there are risks associated with the Keratin lash lift procedure.
I understand that his procedure requires my lashes to be glued to a silicone pad with a water based adhesive and lifted with an advanced solution, conditioning cream, and serum.
I understand that as part of the procedure, eye irritation, pain, itching and discomfort may occur.
I understand and agree to follow the aftercare instructions provided by my technician.
I understand that failure to follow the aftercare instructions may cause an undesirable result.
I understand that my eyes will need to be closed for a duration of up to 75 minutes during the procedure
I understand that opening my eyes at any point during the procedure is not recommended and may cause product to enter my eye, which will result in redness. I agree to keep my eyes closed throughout theprocedure, unless instructed otherwise by my technician
I release my technician and/or Simply Wonderful Nails from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained and certified to use.
By signing here you confirm that all the information provided is correct and agree to all the terms and conditions
*
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