Eyelash Extension/Lash Lift Consent Form
Please complete this form to provide your consent and acknowledge understanding of the eyelash extension or lash lift procedure, associated risks, aftercare, and your agreement to proceed.
Client Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of appointment
*
-
Month
-
Day
Year
Date
Do you have any known allergies? If yes, please specify.
*
Do you have any medical conditions we should be aware of? If yes, please specify.
*
Have you had eyelash extensions or lash lift before? If yes, when.
*
Do you wear contact lenses?
Yes
No
Consent Statements
Please read each statement carefully and confirm your understanding and agreement.
I understand the nature and risks of eyelash extension application/ lash lift, including possible allergic reactions, irritation.
*
I have read and understand this statement.
I acknowledge that I have been informed about aftercare instructions and agree to follow them to ensure the best outcome and minimize risks of eye infection.
*
I have read and understand this statement.
I consent to proceed with the eyelash extension/lash lift application and authorize Maria Guillen to perform the procedure.
*
I have read and agree to this statement.
Consent of photography
I consent to before and after photos for educational and/or marketing purposes
I do not consent to photos
Client Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: