Eyelash Extension Consent form

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. You must be over or the age of 18 to fill this form out.
Full Name *

Name Last name
Date of Birth

MonthDayYear
Date
Age *
Cell phone number *

Area CodePhone Number
Email*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Is this your first time having Eyelash Extensions?*

YesNo
Are you having lash extensions applied for?

Special occasionDaily wear
Do you wear Contacts? _*

YesNo
Do you have , or are you being treated for any eye illness or injury?*

YesNo
Please list any eye drops or eye medication you are currently using
Are you able to lay on your back for 1-3 hours to have your lashes applied?*

YesNo
Will you be able to keep your eyes completely closed for up to 1-3 hours?*

YesNo
Are you pregnant? ?*

YesNo
What other products do you currently use around your eyes? ( eye creams, oinments, lash growers, etc.
PLEASE NOTE USE OF OIL BASED PRODUCTS AROUND EYES SHOULD BE DISCONTINUED FOR 48 HOURS AFTER YOUR EYELASH EXTENSION SERVICE. It is also 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 and your lashes will not last long. *
Please initial
For longevity we recommend not to use mascara ( you're lashes will look so glamorous you won't feel a need to), however if you must, be sure it is oil free and remove it daily with an oil free wash. We recommend our eye wash, or you can may use Sterild or Occusoft ( available at most drug stores).*
Please initial
Do you use lash growers such as Lattice or over the counter ones? It is best to discontinue use of these 2 weeks before you service and discontinue use while you are wearing your lash extensions. Some contain oils and/or steriods and will shorten the duration of your extensions._*

Yes I use, but will pause before appt.No
How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 2 days after your service to allow the adhesive to set properly. _

SideStomachBack
Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.? _*

YesNo
Have you had Chemotherapy Treatments in the last 6 months? _Medication for chemotherapy may cause a reaction to the materials used in this service. Also, if lashes are just starting to grow back they may be a little weak and we recommend waiting until they are strong enough for this service. _*

YesNo
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.). _*

YesNo
Are you currently taking Thyroid Medications? Thyroid medications or Thyroid Conditions may not last long due to either of these.. _*

YesNo
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... _*

YesNo
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... _*

YesNo
Beautiful Lashes can put a serious swagger in your step!We use only high quality medical grade glue andsoft lightweight lashes to give you a glamorous, yet natural look. Here is what you'll experience today.
X
Step 1 - Consultation with your Lash Extension Expert to insure this service is right for you and to explain your before, during and after experience thoroughly.

Step 2 - Select the style of lashes you would like, to cover length, fullness and shape. If you're unsure, your lash tech will be happy to recommend what's best for you and your lifestyle.

Step 3 - Get Lashed Up!

Step 4 - Prebook for your refill in approx 2 weeks . (prebook your next appointment at your first appointment for $5 off your fill).
I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 /12 weeks. I understand if I go beyond this recommended time it may need a full set or incure a higher 'relash' price.*
Initial
I acknowledge and understand that the studio doesn’t do Refunds. The lash tech will Do the best that he or she can to satisfied the customer. I understand that same day cancellations result in a 40% of my service charged.*
Initial
I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks. _*
Initial
I agree and understand that the lash tech has no way of knowing if the client is allergic to some of the products or materials been use in any procedure. *
Initial
I grant permission to use my before and after photos for marketing or examples of my technicians work.*

YesNo
What do you like in the background of your appointment?

Anything is fine with meMusicTv Show/ MovieMy own music playlistSilent Appointment
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 decided if I am a good candidate for this serive to the best of their ability.*
Initial
*

By signing below, I verify that I have read and understand the above statemetns and agree to them. Thank you for the time you took to read, understand and agree to our consent form..
Sign date *

MonthDayYear
Date
Client signature *
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Eyelash Extensions consent form

Beautiful Lashes can put a serious swagger in your step!We use only high quality medical grade glue andsoft lightweight lashes to give you a glamorous, yet natural look. Here is what you'll experience today.