• Eyelash Extension Form

    Includes medical history, eyelash extension and appointment preferences, and consent & liability. Please fill it out truthfully and to the best of your ability, it should only take around 5-10 minutes. Should you have any questions or concerns, feel free to contact me at beautybyjemdj@gmail.com or Instagram @thebeautyjem.

  • Personal Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • Medical History

    Please answer carefully and truthfully for your aesthetician to determine whether you are suitable and able to undergo the procedure and to rule out any contraindications.
  • Do you wear contact lenses? (If yes, please come to your appointment WITHOUT contact lenses as they will react with the glue fumes)*
  • Would you like to do a patch test prior to your appointment? This tests for any allergic reactions to any products used and is typically scheduled 3 days prior to the appointment.*
  • What do you prefer during your appointment? (By the way, you can always ask for a silent appointment, just write it in your appointment notes when you book or let me know in person!)*

  • Eyelash Extension Preference

    Please answer the following questions for your aesthetician to understand your lash preferences and goals.
  • Have you had eyelash extensions applied before? If yes, how often do you get them done?*
  • What's your preferred lash set?*
  • What's your preferred lash shape?*

  • Consent & Liability

  • I confirm I am over the age of 18 or have obtained parental/guardian consent.*
  • I understand I am receiving a lash extension service from "THE BEAUTY JEM/JEMIMA DE JESUS". I understand this procedure requires synthetic eyelashes to be glued to my own natural eyelashes.*
  • I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my technician addresses me to open my eyes and that if I wear contacts I must remove them. Any medical conditions that might be aggravated by lying still in a horizontal position for a prolonged time may mean I will not be able to have the procedure performed on my eyelashes. I understand failure to keep my eyes fully shut throughout the whole procedure can lead to the risks listed below.*
  • I understand that some risks of this procedure may be, but not limited to, chemical burns, discomfort, eye redness and irritation. I understand that even though my technician will perform the service with precision and care, the fumes from the adhesive may cause my eyes to tear up if I open my eyes. Some clients may have an allergic reaction and require the eyelashes to be removed. I voluntarily assume all such risks and release my technician of all liability associated with receiving eyelash extensions.*
  • I confirm and agree to disclose all known allergies, eye conditions, medications, or medical issues that may affect the outcome or safety of this procedure. I disclosed all sensitivities I have to surgical tapes, cyanoacrylate, vaseline, latex, etc. and after my technician’s precautions I have still decided to proceed with application. I understand and agree that my technician will not be held responsible if I experience any issues with my eyes or lashes.*
  • I hereby grant to “THE BEAUTY JEM” the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, solely for marketing purposes on a website or social media without any monetary compensation and/or discount vouchers.*
  • I agree to follow the care and maintenance instructions provided by the artist and that if any follow up care is required or failure to follow these instructions, I acknowledge this will be at my own expense and risk. *
  • I acknowledge that “THE BEAUTY JEM” does not accept refund requests. I agree to communicate any fallout or dissatisfaction within 72 hours of the appointment to guarantee a same week touch-up appointment or removal.*

  • Please review The Beauty Jem policies before proceeding.

  • I have read and understood the policies of “THE BEAUTY JEM”. I understand that those policies and this consent and liability form will be in effect from now and all future appointments and will be applied if necessary and as “THE BEAUTY JEM” sees fit.*

  • Please review The Beauty Jem policies before proceeding.

  • I understand this agreement shall be governed by the laws of British Columbia. This agreement will remain in effect for this procedure, and all future procedures conducted by “THE BEAUTY JEM”. I release my aesthetician of “THE BEAUTY JEM/JEMIMA DE JESUS”, and the property owners of all liability and claims associated with this procedure.*

  • Pre & Post-Care

    View here: https://www.thebeautyjem.com/pre-and-post-care

  • Before your appointment:

    • Please arrive with clean lashes and do not wear any makeup around the area.
      ​
    • Avoid eyeliner, strip lashes, mascara, lash serums, and oil-based eye products for at least 24 hours beforehand.
      ​
    • Avoid having caffeine at least 4 hours prior to your appointment.
      ​​
    • Please remove your contact lenses before we get started; bring your glasses instead.​​​​
      ​
    • Come with ideas or pictures of your desired lash look.

  • After your appointment:

    • Do not use mascara, lash curler, serums, oil-based products, or strip lashes. Use only water-based makeup and skincare products around the eyes.
      ​
    • Avoid sleeping on your face – sleep on your side or back instead. If you’re a side sleeper, make sure your lashes aren’t smushed on the pillow. If you sleep on your stomach, ask me about sleeping masks that are safe for eyelash extensions! We also recommend sleeping on a silk or satin pillowcase to reduce friction.
      ​​
    • Lessen exposure to extreme heat or steam (saunas, cooking, lighting fires, tanning beds).
      ​​
    • Cleanse your lashes daily with a gentle lash cleanser. Washing your lashes will ensure you remove dirt, natural oils, and debris from your eyelids and lashes. You can use a clean eye makeup brush to clean your lashes.
      ​
    • Brush through your lashes gently every few hours with a clean spoolie.
      ​​
    • Avoid touching, rubbing, or pulling your eyelashes.
      ​​
    • Book your lash fill appointment regularly within 2-3 weeks to maintain the look so that grow-outs can be removed and gaps can be filled. You must have 50% or more lash extensions to be considered a fill.​​​
      ​​
    • Book a removal to remove your extensions – please do not remove them yourself.
      ​​
    • Do not be alarmed if your lash extensions are falling out with your natural lashes; it is falling out as part of the natural shedding cycle (2-5 lashes per eye per day).

  • Pre & Post-Care

    View here: https://www.thebeautyjem.com/pre-and-post-care

  • Before your appointment:

    • Please arrive with clean lashes and do not wear any makeup around the area.
      ​
    • Avoid eyeliner, strip lashes, mascara, lash serums, and oil-based eye products for at least 24 hours beforehand.
      ​
    • Avoid having caffeine at least 4 hours prior to your appointment.
      ​​
    • Please remove your contact lenses before we get started; bring your glasses instead.​​​​
      ​
    • Come with ideas or pictures of your desired lash look.

  • After your appointment:

    • Do not use mascara, lash curler, serums, oil-based products, or strip lashes. Use only water-based makeup and skincare products around the eyes.
      ​
    • Avoid sleeping on your face – sleep on your side or back instead. If you’re a side sleeper, make sure your lashes aren’t smushed on the pillow. If you sleep on your stomach, ask me about sleeping masks that are safe for eyelash extensions! We also recommend sleeping on a silk or satin pillowcase to reduce friction.
      ​​
    • Lessen exposure to extreme heat or steam (saunas, cooking, lighting fires, tanning beds).
      ​​
    • Cleanse your lashes daily with a gentle lash cleanser. Washing your lashes will ensure you remove dirt, natural oils, and debris from your eyelids and lashes. You can use a clean eye makeup brush to clean your lashes.
      ​
    • Brush through your lashes gently every few hours with a clean spoolie.
      ​​
    • Avoid touching, rubbing, or pulling your eyelashes.
      ​​
    • Book your lash fill appointment regularly within 2-3 weeks to maintain the look so that grow-outs can be removed and gaps can be filled. You must have 50% or more lash extensions to be considered a fill.​​​
      ​​
    • Book a removal to remove your extensions – please do not remove them yourself.
      ​​
    • Do not be alarmed if your lash extensions are falling out with your natural lashes; it is falling out as part of the natural shedding cycle (2-5 lashes per eye per day).
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