Lash Client Consent Form

Name*

First NameLast Name

Address*

How did you hear about me?*

Mobile Phone Number*

Date of Birth*

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Best Method of Contact*

Phone CallTextEmail

Certain conditions may affect lash retention/growth, how frequent a fill appointment may be required and whether or not you are a good candidate for eyelash extensions.*

I understand

Please check the following conditions that apply to you: (current or in the past)*

Please list any medication or drops you are currently using*

Any recent EYE SURGERIES, INFECTIONS or CONDITIONS? *

Ex: pink eye, blepharitis, styes

Do you experience sensitive eyes, watering or seasonal allergies?*

Have you had lash extensions before?If yes, did you experience any irritation, allergic reactions, or retention issues?*

Are you pregnant or breastfeeding? (Important for sensitivity + retention)*

If yes, how far along are you? Important for bed/pillow accommodations for baby/mom safety)

Do you currently use any lash serums?*

Do you wear contact lenses?*

If you wear contact lenses, please remember to bring your case and solution. Contact lenses need to be removed during the application.

How would you describe your natural lashes?*

SparseFullStraightCurly

How would you describe your own hair?*

Ex: thin, medium or thick (density) ; fine or coarse (thickness)

How do you usually wear your makeup?*

Daily nothing crazyDaily natural glamSpecial occasionsDaily full glam

Do you wear Eye Makeup often? If yes, what do you use?*

Ex: Mascara, Eyeliner, Striplashes

Do you have oily skin or use oil-based skincare for dry skin? *

Name the products :)

Do you swim, work out heavily, or sweat often?*

Ex: hot yoga, HIIT cardio, Sauna use

Do you sleep mostly:*

On your sideStomachBack

Are you applying eyelash extensions for daily wear or a special occasion?*

Have you had lash extensions before?*

If yes: what did you like about them? What did you dislike?

If yes: Did you ever experience burning, irritation during or after the service?

If yes: how was your retention with past services?

Ex: pretty good, average, poor retention

Do you prefer a softer or more dramatic result?(Soft/Natural, Medium/Noticeable, Bold/Dramatic)*

Do you prefer a lash style that:*

What curl type are you most drawn to?(J, B, C, CC, D, L..)*

If you are unsure, it’s okay :) I would love to recommend the best curl and customized your lash set

Are there any inspiration photos you’d like to share?

Do you want a noticeable change, or something subtle/enhancing?*

How much time do you want to spend on lash aftercare?*

Not too longEnough timeI don’t mind spending some timeI will add it to my skin routine :)

Are you aware of the aftercare steps? *

If not, I will provide you with a personalized lesson during your appointment on how to properly cleanse and care for your lashes, ensuring the longevity of your investment.

Would you like me to show you how to properly clean and care for your lashes?*

Yes please!!!No I think I got it covered :)

Do you want recommendations for aftercare products? (Lash shampoo, brushes)*

Yes 🤍I think soNo, it’s okay

Would you like to explore ADD-ON Services?*

I’m interested in a Brow LaminationI’m interested in a Brow Wax and TintI’m interested in red light therapyI’m interested in a Brow wax onlyI’m interested in a Brow tint onlyI’m interested in Tinted FRECKLES! 🫶🏻Maybe! :)

Are you interested in a lash membership, or package for regular fills?*

Yes!!No really

How often would you like to come for fills?*

WeeklyEvery 2 weeksEvery 3 weeks

Do you want me to recommend the best style for your eye shape and face symmetry?*

Yes :)No

If yes, would you like a bespoke lash mapping preview before we begin? I will provide you with a tailored visual showcasing how various lash designs will enhance your unique features.

YesNo

Kindly upload a front-facing photo of your face with good lighting and visible eyes. This will allow me to map your lashes before our appt 🫶🏻 — Smile! 😄*

Any adjustments can be made during your in-person consultation at the appointment

Is there anything else I should know about your lashes, eye health, or personal preferences?

Please read and initial the following statements:

enter your initials for each statement

I understand the importance of disclosing my health history and other requested details on the Client Information Form and have not withheld any conditions which may affect this procedure.*

I understand that synthetic eyelash extensions will be applied to my natural lashes with special adhesive during this service*

I understand that the technician will apply the eyelash extensions to my natural lashes in such a way to prevent any damage and maintain the health of my lashes. As a result, my desired look may not be achieved.*

I understand that I am required to lie still with my eyes closed for up to 3 hours or more during the appointment. Opening my eyes prematurely can expose them to the fumes from the adhesive and cause a reaction.*

I understand the risks associated with this procedure may include, but are not limited to, itching, redness, irritation, allergic reaction and potential blindness (rare)*

I understand that my natural lashes will grow and fall out naturally. In order to replace the fallen lashes and maintain the original look, a fill appointment will be required (usually 2-20 days after last service)*

I understand that should an allergic reaction occur, I will contact the technician immediately to arrange for the removal of the lash extensions. I will also seek medical attention from a physician at my own expense. I understand that no refund for the initial service will be provided.*

I will follow the aftercare instructions provided by the technician and not attempt to remove the lash extensions on my own. If I pulled my own lash extensions before a fill, I will need to pay extra for the fill or get a new full set.*

I understand that the adhesive remover used during removal of the extensions may contact my eye and cause a reaction that may require medical attention at my own expense.*

I agree to have photographs/videos taken of myself before, during and after the procedure. I grant permission for my image or likeness to be used for marketing and other purposes including display on social media accounts or a website. I also agree to any image retouching required by the technician. I assign any copyright in the photographs/videos to the technician.*

I agree to defend, indemnify and hold harmless the technician below from any and all claims, actions, expenses, liabilities and damages, including reasonable attorney fees, which may be asserted against the technician due to this or future procedures or purchase of any products.*

IMUA Studios LLC policies:

1. Booking Policy

• A non-refundable deposit of $25 is required to secure all appointments. This deposit will be applied to your service total. (Some services don't required a deposit)

• Appointments must be booked at least 24 hours in advance. Walk-ins are not accepted at this time.

• A confirmation text or email will be sent 24 hours before your appointment. Please confirm to avoid automatic cancellation.

2. Cancellation & Rescheduling Policy

• We require at least 48-24 hours’ notice for cancellations or rescheduling. Deposits for cancellations made within this window can be transferred to a future booking.

• Cancellations or rescheduling requests made less than 48-24 hours before the appointment will result in the loss of your deposit. And 50% charge for the service.

• No-shows will be charged 100% of the service cost and will require full prepayment for any future bookings.

cancellations due to emergencies:

I understand things can happen. I believe in compassion and understanding. due to this, if you are sick, your kid is sick, you got into a car accident, etc we can reschedule. I will only need a 100% full payment of the service missed the day of. I will not charge the 100% cancellation fee, and put that money towards your next rescheduled appointment. At the new appointment new fees cost could be added due to different fill prices depending of the days after the last service.

3. Late Arrival Policy

• A 15-minute grace period is allowed for late arrivals. If you arrive more than 15 minutes late, your appointment may need to be rescheduled, and your deposit will be forfeited. You will need to pay a late fee (for 15min late) or reschedule if it's more than 30 min and pay 50% cost of the appt missed.

• If time permits, we may proceed with a shortened service, but the full service price will still apply.

4. Refund Policy

• Due to the nature of our services, we do not offer refunds. If you experience any issues with your lashes, please contact us within 72 hours of your appointment to schedule a complimentary touch-up.

5. Hygiene & Safety Policy

• Please arrive with clean, makeup-free lashes to ensure the best results.

• Only one guest is allowed in the studio with you during your appointment. If you have a baby or kid younger than 1 year old, she/he is welcome to come with you. I support moms!

6. Age Requirement

• Clients must be at least 18 years old to receive services. Parental consent is required for clients under 18.

7. Payment Policy

• We accept cash, major credit cards, and digital payments. Full payment is required at the end of your service. If payment is not made or card on file is not active or cancel. An invoice will be sent everyday until payment is complete. Interest 1% will be added for every day payment is late. After 31 days, the total balance with interest will be sent to a collection company or sent to small claims for theft of services/fraud.

I Agree to all IMUA Studios LLC business policies*

By signing below, I certify that I have read and fully understand the above statements and have had adequate opportunity to have any questions or concerns addressed. I understand the procedure and accept the risks. I understand that this agreement is legally binding. I confirm that I am over the age of 18, of sound mind and fully capable of executing this waiver for myself. (Parental consent will be required if under 18 years old This agreement will remain in effect for this procedure and all future procedures provided by the technician below.

Signature