Client Consultation
There is a separate Informed Consent Form you will sign the day of your treatment. If you are under 18, your parent or guardian will need to sign for you.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Birthday
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
I am informing my technician of any of the following contraindicated conditions for a lash lift or lash tint.
Allergies to adhesive tape, fumes or makeup remover
Dry Eye Syndrome
Sjorgen's Syndrome
Active Chemotherapy
Ocular Rosacea
I am informing my technician of any of the following contraindicated conditions for a brow lamination or brow tint.
Active Chemotherapy
Psoriasis
Eczema in Treatment Area
Alopecia
Sun Burn
Ultra Sensitive Skin
Wounds in Treatment Area
I consent to having my eyes closed and covered for the duration of the 45-90 minute procedure.
*
Yes
No
I wear contacts.
*
Yes
No
I, undersigned, accept the following statements:
*
I agree to have a lash lift, brow lamination and/or lash/brow tint applied to my natural eyelashes or brows and/or retouched. By signing this agreement, I consent to the procedure of a lash lift, brow lamination, or lash/brow tint by my technician.
I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash tint.
I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.
I understand that some mild but normal symptoms may occur with the brow lamiation depending on the sensitivity of my skin during the procedure and will subside in 24 hours. These symptoms may include: mild tingling, slight redness due to brushing the hairs, slight warmth in the area.
I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.
I understand that even though my technician perms the lashes/brows using the proper technique, the instruments, tapes, cleaners, adhesives, and removers used may irritate my eyes/brows or require a physician’s follow-up care.
I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes/eyebrows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told.
I agree to the following Post-Treatment Instructions:
*
No water can come in contact with the eye area for 24 hours after the application.
Avoid makeup such as mascara, eyeliner, or brow gel or pencil for the first 24 hours.
Avoid using oil containing sunscreens, moisturizers and cleansers on lashes or brows for the first 24 hours.
Signature
*
Submit
Submit
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