Eyelash Extension Consent Form
Thank you for choosing Glow & Grow Parlor! I am looking forward to glowing with you! Just a few things first!
Name
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First Name
Last Name
Phone Number
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Format: (000) 000-0000.
Email
*
example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State Driver's License/ ID 🪪: I confirm that I am 18 years of age or older. I understand and agree to the following:I must be at least 18 years old to receive lash and/or brow services at Glow N Grow Parlor.I am required to provide a valid government-issued ID (Driver’s License, State ID, Passport, etc.) for age verification.I agree to upload or present my ID for verification before services are performed.My ID will be used only for verification purposes and will not be shared, posted, or used for any other reason.Glow N Grow Parlor reserves the right to refuse service if valid identification is not provided.By signing below, I confirm that all information provided is true and accurate.
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Health History | Please check any of the following that applies to you
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Allergy to adhesives band aid or medical tape
Allergy to surgical glue 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 ever had eyelashes extensions before?
Yes
No
If no, we would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)
Yes
No
Are you allergic to dogs or cats, and are you comfortable with them being present on the premises during your appointment? ( Yes or No)
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Please agree to the terms and conditions
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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 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.
In order to book an appoitment there is a 50% NON REFUNDABLE RETAINER.* This retainer goes toward the cost of holding the appoitment time, and supplies. Remaining balance is due the day of service. All payments and services are final.No refunds will be issued under any circumstance, including dissatisfaction with style, retention, or personal preference after the service is completed.If I have any concerns, I must notify Glow N Grow Parlor within 72 hours of my appointment.Within this 72-hour window, a one-time complimentary follow-up or adjustment may be offered to improve my results.Any concerns or touch-ups requested after 72 hours will require booking a paid service.
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I Agree & Understand
I, _________(client name), give Glow N Grow Parlor permission to take before, during, and after photos or videos of my lash and/or brow services.I understand and agree that:These images may be used for marketing, social media content, portfolio building, website use, advertisements, educational posts, or any other business purposes.My photos may appear on platforms including but not limited to Instagram, Facebook, TikTok, Google, or the Glow N Grow Parlor website.My identity will not be misrepresented, and the photos will be used solely to showcase the service results.I will not receive compensation for the use of these images.I may withdraw permission at any time for future use by providing written notice. Previously used content cannot be removed or undone.By signing below, I acknowledge that I have read, understand, and agree to the terms above.Client Signature: Print Name & Sign Below
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Date of Signature
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Month
 -
Day
Year
Date
How did you hear about us?
Website
Magazine
Web search
Friend
Other
Client signature
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