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  • Client Assessment Form

  • Format: (000) 000-0000.
  • Have you had Eyelash Extensions before?*
  • Do you wear*
  • Are you currently pregnant?*
  • Check any of the conditions that may apply to you: (The following are potential contraindications for eyelash extensions)*
  • Do you experience any of the following?*
  • My natural lashes are…*
  • Todays Date*
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  • EYELASH EXTENSION CONSENT, LIABILITY WAIVER & INDEMNIFICATION AGREEMENT

  • 1. PROCEDURE & RISKS

    ☐ I understand extensions involve bonding synthetic lashes to my natural lashes using professional adhesive.

    ☐ I understand the process may take 1–4 hours, and I must remain still with eyes closed.

    ☐ I understand Eyelash extensions require regular maintenance every 2–3 weeks.
    ☐ I understand potential risks include, but are not limited to; irritation, allergic reactions, redness, swelling, infection, lash damage, premature shedding, and possible eye injury.
    ☐ I understand reactions may occur even if I’ve had extensions previously with no issues.


    2. MEDICAL & ALLERGY DISCLOSURE

    ☐ I have fully disclosed all allergies, sensitivities, medications, and eye/skin conditions as well as other conditions and disabilities that might affect this procedure.
    ☐ I understand failing to disclose information increases risks.
    ☐ I agree to seek medical care at my own expense if complications occur.

    ☐ I agree to remove contact lenses prior to service (if applicable).

    3. AFTERCARE & PERSONAL RESPONSIBILITY

    ☐ I agree to follow all aftercare instructions.
    ☐ I accept responsibility for the condition and health of my natural lashes.

    4. NO GUARANTEES

    ☐ I understand results vary, and no guarantee is made regarding retention, longevity, or appearance.

    5. ASSUMPTION OF RISK

    ☐ I voluntarily assume all risks, known or unknown, associated with eyelash extensions.

    6. LIABILITY WAIVER & RELEASE

    ☐ I release and hold harmless the lash artist, employees, and Serving Beauty from all claims, damages, demands, or liability, including those arising from negligence, to the fullest extent permitted by law.

    7. INDEMNIFICATION

    ☐ I agree to indemnify and hold harmless the lash artist and Serving Beauty from any claim or expense (including attorney’s fees) resulting from my failure to disclose information, follow aftercare, or misuse of extensions.

    8. BINDING EFFECT

    ☐ I understand this agreement is legally binding and applies to all current and future services unless revoked in writing.

    9. PHOTO CONSENT

    ☐ I understand and agree that Serving Beauty may take photos or videos before, during, and after the procedure for documentation, quality control, and marketing purposes.

    10. APPOINTMENT, PAYMENT & CANCELLATION POLICIES

    ☐ I understand and agree to Serving Beauty policies

    ☐ $20 deposit required to reserve an appointment 

    ☐ I understand Same day cancellation and no-shows forefits my deposit.

    ☐ No refunds for any services rendered.
    ☐ Cancellations must be made 48 hours in advance.
    ☐ A fee may apply for late cancellations or no-shows.
    ☐ Refill appointments require at least 40–50% lash retention or I will be charged as a full set.

    11. PATCH TESTS

    ☐ Patch tests are recommended for first-time clients or those with sensitive eyes. Patch tests must be completed 24-48 hours before your scheduled appointment. 

    12. SERVICE DISCRETION 
    ☐ Services are provided at the Serving Beauty's discretion. Serving Beauty may decline to provide, suspend, or terminate services at any time, with or without notice, and is not required to provide an explanation for such action.

    By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional. 

  • Date*
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  • Should be Empty: