Eyelash Extensions Client Information & Consent Form
@Jensbeautylashess
Full Name:
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First Name
Last Name
Birthday
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever had extensions before?
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Yes
No
Have you ever experienced an allergic reaction to eyelash extensions (e.g., adhesives, latex)?
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Yes
No
If yes, please specify:
Do you have sensitive eyes?
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Yes
No
Do you have watery or dry eyes?
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Watery
Dry
Which side do you predominately sleep on?
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Left
Right
Back
Stomach
Are you pregnant?
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Yes
No
Do you wear glasses or contacts?
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Glasses
Contacts
Both
None
Are you able to sit still with your eyes closed for 3+ hours?
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Yes
No
Do you have oily, dry, or combination skin?
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Oily
Dry
Combination
Have you had any eye surgery or injury within the last 6 months?
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Yes
No
Please list any allergies you have (including pets):
By checking the following boxes, confirm that you willingly consent to the following terms and conditions:
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I understand that lash extensions involve the use of adhesives and materials near my eyes, which may cause irritation, allergic reactions, or other complications. I acknowledge these risks and agree to proceed voluntarily.
I understand that proper aftercare is essential to maintain my lash extension and minimize risks. I will follow the aftercare guidelines provided by the technician.
I acknowledge that lash extensions may shed naturally with my natural lash growth cycle, requiring regular fills every 2-3 weeks to maintain the desired look.
I understand that the lash artist will aim to achieve my desired style but cannot guarantee exact results due to the condition of my natural lashes.
I acknowledge that the lash extension application may take up to 3 hours, depending on the complexity of the service and my natural lash condition. I understand that this time frame ensures the best results and quality of work.
I agree not to use oil-based products, waterproof mascara, or other products that could weaken the adhesive bond.
I acknowledge that if I experience an allergic reaction, I should contact the technician immediately, and lash removal may be necessary.
I understand that lash removal must be performed by the technician or a trained professional to avoid damage to my natural lashes.
I acknowledge that lash retention may vary due to factors beyond the technician's control, including oily skin, hormonal changes, or exposure to certain environments or products.
I understand that I am not experiencing any symptoms of illness and will notify the technician if I feel unwell before my appointment.
I acknowledge that the technician follows strict hygiene practices to ensure my safety, including sanitizing tools and equipment.
I understand that a $15 deposit is required to secure my appointment and is non-refundable.
I understand that if the technician needs to cancel my appointment, a refund will be issued.
I acknowledge that if I have any issues with my lashes, I must notify the technician within 48 hours. After 48 hours, any fixes will be charged as a fill.
I understand and consent to the technician's no-show and cancellation policy, including the charge for no-shows or late cancellations.
I understand and consent to the technician's rescheduling policy, including the charge for reschedules. I understand that rescheduling within 24 hours of my appointment will incur a $10 fee.
I understand that my remaining balance is due in cash at the same time of my appointment. If I choose to pay the remaining balance via Zelle, I agree to a $5 convenience fee.
I consent to photos/videos of my lashes being used for promotional purposes.
I confirm that the information I have provided is accurate and complete. I understand and consent to the terms outlines in this consent form.
Acknowledgement & Consent
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By signing below, I confirm that I have read, understood, and agree to the terms outlined in this Lash Extension Consent Form. I voluntarily consent to the application of lash extensions and accept the associated risks, policies, and aftercare responsibilities.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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