Eyelash Client Consent Form
Thank you for choosing Lashedbyliyahh. We look forward to seeing you soon!
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Instagram Handle
*
Example: @lashedbyliyahh
Emergency contact
*
First and Last Name
Relationship with this person
Phone Number
*
Format: (000) 000-0000.
How did you hear about us?
Instagram
Referral
Friend
Other
Health history | Please check any of the following that applies to you
Allergy to adhesives or medical tape
Allergy to surgical or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you had Lasik surgery or any eye surgery in the last 4 months? *Eyes may be sensitive to eyelash extensions and products to prep the eye area*
*
Yes
No
Have you ever had eyelash extensions before
*
Yes
No
Have you ever experienced any allergic reaction to eyelash extensions or false lash adhesives
Yes
No
If you’ve had eyelash extensions please specify any reactions or sensitivities
*
Do you wear contact lenses? (If yes, please remove them before your appointment)
Yes
No
Is this your first time getting eyelash extensions
*
Yes
No
Do you often pick, pull, rub your lashes for any reason?
*
Yes
No
Do you use eye products? Such as eye creams/ makeup etc.
*
Are you allergic to dogs? (If so, please notify your technician upon booking. Dogs are in a separate area from work space.)
*
Yes
No
Will you be able to lay on your back for 2-3 hours?
*
Yes
No
Policies
Please come bare face and clean lashes. Avoid caffeine and energy drinks. No extra guests allowed. Wear comfy clothes. Comfortable hairstyle (no low ponys/ buns). I have dogs that will be in a separate area from my lash room (There will be occasional barking). Please let me know prior if you have any allergies. Please use restroom prior to your appointment, restroom is available for clients to use.The address will be sent 48 hours prior to your appointment. Please notify me once you have arrived and wait in your car, I will message you to come in
Late/ Cancellation policy
10 minute grace period to arrive to your appointment. 15 min= automatic cancellation/ you will need to reschedule and send new deposit. No shows will be banned from booking. I understand life and things happen. Please let me know 24 hrs prior to your appointment if you need to cancel/ reschedule. Deposits are non-refundable.
Deposit info
$25 non refundable deposit required after booking on website, this will go towards the remaining amount of your balance. Please message me before sending deposit. Remaining balance must be paid in cash
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur. I agree to contact the business immediately in the event of an allergic reaction and to contact a physician at my own expense. I understand that due to the business being complete, a refund will not be issued and I will contact the business for a free lash removal
I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.
I give my technician consent to use before and after photos for marketing as well as examples to show to other potential clients.
I have read, understood lashedbyliyahhs policy and agreements
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: