Consent and Intake Form

I   First Name*Last Name*   agree to have eyelash extensions applied to my natural eyelashes and/or removed. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional.  

 Initial*   I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes, I will contact the certified eyelash extension professional that performed this procedure, and it may be beneficial to have the eyelashes removed.  

 Initial*   I understand and agree to the aftercare instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out, and/or impact the longevity. 

 Initial*   I understand and consent to having my eyes closed and covered for the duration of procedures for 30 min or more. Times vary depending on the type and number of eyelashes applied. 

  Initial*   I understand that if my skin comes in contact with the bonding agent some irritation may occur.  

 Initial*   This agreement will remain in effect for this procedure and all future follow–ups conducted by the certified eyelash extension professional. I understand that this consent agreement is legal. I have read and fully understand all information in this agreement.  

 Initial*   I am at least 18 years of age or I am a parent/legal guardian and consent to the agreement and to the eyelash extension application procedure.