Eyelash Extension Consent Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any allergies (especially to adhesives, latex, cyanoacrylate, or eyelash products)?
Yes
No
Have you ever experienced a reaction to eyelash extensions, lash lifts, strip lashes, or adhesives?
Yes
No
Do you have sensitive eyes or skin?
Yes
No
Do you have or have had any eye conditions (conjunctivitis, blepharitis, styes, dry eyes, glaucoma, recent eye surgery, watery eyes, seasonal allergies)?
Yes
No
If yes, please specify below.
Are you pregnant or breast feeding?
Yes
No
Have you ever had eyelash extensions before?
Yes
No
Do you understand that eyelash extensions require proper maintenance, including regular fills, careful aftercare (avoiding rubbing, picking, oil-based products, steam, or sleeping on face), and that results vary depending on your natural lash health and growth cycle?
Yes
No
Consent & Liability
Do you understand that reactions (redness, itching, swelling, irritation) are possible with lash adhesives?
Yes
No
Do you release the technician from liability for reactions due to undisclosed conditions or failure to follow aftercare?
Yes
No
Do you give consent for before and after photos (for records/marketing purposes)?
Yes
No
Signature
Continue
Continue
Should be Empty: