• Lash Service Consultation Form

    Please fill out this form directly after booking your appointment.
  • All fields marked with a * are required and must be filled.

  • Format: (000) 000-0000.
  • Please select the service you are receiving*
  • Have you ever received a Lash service (i.e. lash lift, tint, or extensions)?*
  • How well do your eyelashes hold a curl when using an eyelash curler?*
  • Do you wear contacts? If yes, I ask that you remove them before the service.*
  • Are you currently pregnant?*
  • I consent to having my eyes closed for the duration of the service.*
  • Read the following before signing.

    By signing this agreement, I consent to the procedure of a lash service by my Esthetician. I understand that as with any beauty service, there are risks associated with eyelash extensions and an eyelash perm/tint. I further understand that as part of the procedure, potential reactions such as eye irritation, discomfort, redness, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these reactions with my lashes I will contact my Esthetician and/or consult a physician at my own expense. I understand and agree to the after care instructions provided by my Esthetician for the use and care of my eyelashes. I realize and accept the consequences that failure to adhere to these instructions may cause the eyelashes to not last as long as told. I agree to the following lash service aftercare: no water can come in contact with the eye area for 24 hours after the application, avoid using oil containing products on eyelash extensions, avoid using an eyelash curler. I release my Esthetician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application, using tools and products that the Esthetician has been professionally trained to use. There are no guarantees for length of time the lashes will stay applied/permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the longevity of the eyelash service, such as premature water and/or moisture contact, weather conditions, and activities involving exposure to high temperatures. Acknowledgment and waiver: I am over 18 years of age and consent to the agreement and procedure or have a parent that consents to the procedure. This agreement will remain in effect for this procedure and all future procedures conducted by my Esthetician. By signing below, I verify that I have read and fully understand the above statements and agree to them.

  • Date of signature *
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