Eyelash Extension Consent Form
Thank you for choosing Get Lashed by Chels. Your completion of this form ensures clear communication and legal protection for both client and artist.
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?
Instagram
Friend or Family Referral
Other
Health History | Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Drugs that can cause temporary hair loss
Major surgery within last 120 days
Other
Have you ever had eyelashes extensions before?
Yes
No
PATCH/ALLERGY TESTS: Patch or allergy tests are available upon request. If booked, a small number of lash extensions will be applied to a designated area on one or both eyes at least 72 hours prior to your appointment to monitor for any allergic reactions. Patch tests must be requested via direct message before booking, and at least one week’s notice is required to allow sufficient time for testing.
Yes, I would like a patch test.
No, I do not require a patch test
FOREIGN FILLS: Foreign fills are accepted. By booking this service, you acknowledge and agree to the following:Lash extensions applied by another artist may differ in style, length, curl, or adhesive used, which can affect retention and overall results.Get Lashed by Chels is not responsible for prior application errors, damage, or premature lash loss caused by previous extensions.A thorough consultation will be conducted to assess your natural lashes before proceeding.Additional fees may apply for removal, correction, or adjustments necessary to safely apply new extensions.By signing this form, you release Get Lashed by Chels from any liability related to prior lash work, retention issues, or results of the foreign fill service.
Signature
CLIENT CONSENT & RELEASE:By signing this form, I acknowledge and agree to the following:
Eyelash extensions involve applying semi-permanent extensions to natural lashes using professional adhesive.
Potential risks include irritation, redness, allergic reaction, infection, or natural-lash damage if aftercare instructions are not followed
All medical and allergy information I have provided is complete and accurate.
I release Get Lashed by Chels, its owner, and any assistants from all liability for allergic reactions, eye irritation, or damages that may occur before, during, or after the service.
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.
Date
-
Month
-
Day
Year
Date
Client Signature
Technician Name
First Name
Last Name
Technician Signature
LATE & CANCELLATION POLICY:Please arrive on time; appointments will not be extended for late arrivals.Arrivals more than 15 minutes late without notice will be treated as a cancellation and incur a fee.Cancellations or rescheduling must be made at least 48 hours in advance.Last-minute cancellations are subject to a 50% service fee.No-shows may result in being restricted from future bookings.
I have read, understood, and agree to the policies outlined above, including the late and cancellation consequences.
Type a question
REFUND POLICY: All services are non-refundable; refunds will not be issued for completed lash services, dissatisfaction due to natural lash shedding, or client preference changes, and any errors during the service will be corrected at the discretion of Get Lashed by Chels.
acknowledge that I have read, understood, and agree to the Refund Policy.
Acknowledgment: I confirm that I have read and understood the above Terms and Conditions, and that all information I have provided is true and accurate.
Signature
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