Eyelash Extensions Consent Form.
Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.
Full name
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First Name
Last name
Do you wear Contacts?
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Yes
No
Do you have , or are you being treated for any eye illness or injury?
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Yes
No
Are you able to lay on your back for 2-3 hours to have your lashes applied?
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Yes
No
It is recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive & this may affect retention. This may also result in excess buildup & lead to poor ocular hygiene.
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Please initial and date you read and understand the above.
For longevity we recommend not to use mascara, lash curlers, saunas, or over exposure to heat. I understand i need to cleanse my lashes DAILY.
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Please initial and date you read and understand the above.
Are you allergic to adhesives ( LATEX, glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may cause an allergic reaction. I use a medical grade, formaldehyde free glue, but allergies may still occur. _
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Yes
No
Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (gel pads, glues, etc.). _
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Yes
No
Blephoroplasty or other eye condition or surgery in the last 6 months? Blephoroplasty , eye surgery or conditions may have sensitivity to eyelash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service... _
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Yes
No
Do you wear Contact Lenses:Contact Lenses MUST be removed prior to eyelash extensions procedures. Products may get underneath the contact lens and cause an abrasion or scratching... _
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Yes
No
Do you have Extremely OIly skin and.or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, merely it may require consistent maintenance appointments every 2 weeks.
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Yes
No
I acknowledge and understand that Lashed Savvy doesn’t do Refunds. The lash artist will Do the best that she can to satisfy the customer.
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Initial
I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. I understand the adhesive is a known IRRITANT. All of my questions were answered and I understand the procedure and risks. _
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Initial
I agree and understand that the lash tech has no way of knowing 100% if the client is allergic to some of the products or materials being used.
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Initial
I acknowledge any after hours or holidays booked come with at LEAST a $35 upcharge
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Initial
I grant permission to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I acknowledge the Cancellation/No show/Rescheduling policy: Any Cancellations or reschedules that occur LESS than 24 hours in advance will be charged 100% of the total service fee & the deposit is lost. One reschedule is allowed; beyond that, another deposit is required. No shows will be banned from booking.
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Yes
No
I acknowledge that I will be charged $10 in addition to my service fees if I am more than 10mins late. ($10 PER every 10 mins I am running behind. )
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Yes
No
I acknowledge that If I am attempting to book a foreign fill- I need a consultation to confirm my artist can work over the previous work; If proper isolation was NOT rendered, I will need a removal.
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Yes
No
I acknowledge that If I book a fill & I need a full set, I may be turned away. I also acknowledge 40-50% of extensions remaining is considered a fill. Anything beyond 3 weeks will be considered a full set.
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Yes
No
I release my certified lash technician from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decide if I am a good candidate for this service to the best of their ability.
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Initial
Consent
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By signing below, I verify that I have read and understand the above statemetns and agree to them. I understand I have a 24 hour grace period to get any lashes fixed anything after that will be a charge. I understand that I have to keep my lashes clean to avoid any ocular conditions that result from poor hygiene.
Sign date
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Month
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Day
Year
Date
Client signature
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Submit
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