Lash lift

Name*

First NameLast Name

Date of birth*

Date

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example@example.com

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Format: (000) 000-0000.

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If so, when?

YesNo

List any allergies you have:

List any illness, medical condition, or medical treatment you are being treated by a physician for:

List any medications or supplements you are currently taking

Although every precaution will be taken to ensure your safety and well-being before, during, and after your lash lift & tint, please be aware of the following information and possible risks. Please initial:

I understand that there are risks associated with having a lash lift & tint.*

I understand that as part of the lash lift & tint procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blurred vision could occur.*

I agree that if I experience any of these conditions with my eyelashes or eyes, that I will contact my technician; if I choose to consult a physician, it will be at my own expense.*

I understand that a lash lift will lift my natural eyelashes. Results may vary depending on my natural eyelash length and strength.*

I understand and agree to the aftercare instructions provided by my technician for the use and care of my natural eyelashes after the lash lift & tint. I realize and accept that the consequences of failure to adhere to these instructions may cause the eyelashes to not stay as lifted as long as originally told.*

I understand and consent to having my eyes closed and covered for the entire duration of the procedure. *

I agree to the following eyelash lift care and maintenance instructions:

Be gentle with your lashes; no rubbing or pulling.
Do not get your lashes wet for the first 24 hours.
Use of sauna/steam is possible after 24 hours, but may weaken the effect of the lift.
Swimming should be avoided for at least 24 hours.
No makeup for the first 24 hours.
Do not use harsh products on your eyes or lashes.
No lash extensions or lash strips.
Do not curl your lashes with an eyelash curler.

This agreement will remain in effect for this procedure and future procedures conducted by my technician. If I have any concerns, I will address these with my esthetician. I give Buddah Brows & Beauty permission to perform the lash lift & tint procedure we have discussed and will hold her or associates harmless from liability that may result from this treatment.

I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently using. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult my esthetician immediately.

I certify that I have read and fully understand the information given. I understand the procedure and accept the risks. I do not hold, Buddah Brows & Beauty or known associates responsible for any of my conditions that were present, but not disclosed at the time of the procedure that may be affected by the treatment performed today.

By signing below, I am over 18 years of age, I verify that I have read, understand, and consent to the agreement and to the last lift & tint procedure.

Name*

First NameLast Name

Date*

Date

Signature*

Lash Lift & Tint Consent Form