Eyelash Extension Consent Form
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
*
Website
Magazine
Web search
Friend
Other
Health History | Please check any of the following that applies to you
*
Allergy to adhesives band aid or medical tape
Seasonal allergies
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Other
Have you ever had eyelashes extensions before?
*
Yes
No
If yes, where have you had them applied and what brand was used?
*
Please agree to the terms and conditions
*
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.
Date
*
-
Month
-
Day
Year
Date
Client Signature
*
Do Not Fill Out- For Professional Use Only---Client Front View Photo- Before Lash Extensions
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IDENTIFY CLIENTS EYESHAPE
*
ALMOND
CLOSE SET
DOWNTURNED
HOODED
MONOLID
PROTRUDING
ROUND
UPTURNED
WIDE SET
Do Not Fill out - For professional use only Client formula
Notes for clients requests and formula
Client After Lash Extensions Front View Photo
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