WinksByCasey lash form

WinksbyCasey Lash Extension Consent Form

Hi love! Thank you for choosing to book with me, please read ALL content accordingly and contact me for any questions or concerns. Hope to see you soon!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Appointment date *

MonthDayYear
Date
Instagram handle *
IMPORTANT REMINDERS:

Please read thoroughly before continuing

- Be sure to pay the mandatory NONREFUNDABLE $20 deposit, if deposit is not received within 24 hours, your appointment is INVALID and will be canceled

- a 5 min grace period will be given after 6 mins appt will be canceled

- As a home based lash technician, please be mindful and respectful of the circumstances. NO EXTRA GUESTS

- MUST use the restroom elsewhere before coming to your appointment

- No prior use of mascara or lash products at least 24-48 hours in advance. Come with a clean and bare face the day of appointment.

-If you plan on being late just let me know! Cancellations/Rescheduling MUST be done at least 48 hours before intended appointment date.

-Masks are optional but encouraged. If you are sick please reschedule i am able to accommodate scheduling changes.
Agree
Agree
Agree
Currently using contact lenses and must be responsible for taking them out before application at appointmentAny allergies or eye sensitivities to instruments, fumes, tapes, cleaners, eye pads, and adhesives that could cause my eyes to water and blink in excessHistory of recurrent eye or tear duct infectionsOther medical conditions which would prohibit or compromise placement and retention of eyelash extensionsNone
No waterproof or regular mascaraNo oil based products around area of eyesNo water coming in contact with areas of the eyes within the first 24-48 hours of applicationNo aggressive pulling or rubbing of eyelash extensions
Agree
I understand that if I have any concerns, I will address these with my technician. I give permission to my technician to perform the lash extension procedure we have discussed. I also consent to "before and after" pictures for the purpose of documentation, potential advertising and promotional purposes. I give permission to my technician to perform the lash extension procedure we have discussed, and will hold her harmless and nameless 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 lash extension specialist 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 the lash extension specialist 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 lash extension specialist responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.*

Agree
Signature*
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WinksbyCasey Lash Extension Consent Form