Lash Extension
Consent Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever had lash extensions?
Yes
No
If yes, did you have an adverse reaction to the service? Please describe.
Are you currently being treated for any eye illnesses or injury?
Yes
No
If yes, please describe.
Do you wear contacts
Yes
No
Are you currently pregnant?
Yes
No
Please list all allegations you have.
Read the following before signing.
By signing this form, I consent to the eyelash service performed by my Esthetician. I understand that, as with any beauty service, there are risks, including possible irritation, redness, discomfort, and in rare cases, infection or temporary blurriness. If I experience any reaction, I will notify my Esthetician and/or seek medical attention at my own expense.I agree to follow all aftercare instructions and understand that not doing so may affect the longevity of my lashes.Aftercare Agreement:Keep the eye area dry for 24 hours after application.Avoid oil-based products on or near the lashes.Do not use an eyelash curler.I release my Esthetician from all liability related to this procedure, performed with professional tools, products, and training. I understand that results and retention may vary due to factors such as moisture, weather, and heat exposure.I confirm that I am 18 years or older, or have a parent/guardian consenting to this service. This agreement applies to this procedure and all future lash services with my Esthetician.By signing below, I confirm that I have read, understand, and agree to the terms above.
Date of signature
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Sign (type) your name here.
Continue
Continue
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