Lash Lift and/or Brow Lamination Treatment Consent Form

Lash Lift and/or Brow Lamination Treatment Consent Form

Please complete this form to provide your consent and disclose relevant health information before your eyelash or brow service.
Full Name

First NameLast Name
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Do you consent to having your eyes closed and covered for the duration of the 45-60 minute procedure?
Please indicate any of the following that apply to you:
If you selected 'Other medical conditions', please specify:
Consent & Procedure Agreement
I agree to have an eyelash lift (perm) and/or eyelash tint and/or eyebrow tint applied to my natural eyelashes, brows and/or retouched. By signing this agreement, I consent to the procedure of an eyelash or brow perm, eyelash tint or eyebrow tint by Crowned By Catherine.I understand there are risks associated with having an eyelash perm and/or eyelash/eyebrow tint. I further understand that as part of the procedure, eye/skin irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my lashes/skin that I will contact Crowned By Catherine and consult a physician at my own expense.I understand that even though my technician perms the lashes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/skin or require a physician’s follow-up care.I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes/eyebrows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes or brow service to not stay permed as long as told.I confirm to notify Crowned By Catherine and seek medical attention if needed if I have a negative reaction to any services provided.
Post-Treatment Care Instructions
I agree to the following Post- Lash Lift/Eyelash Tint/Eyebrow Tint:

- No water or steam can come in contact with the eye/brow area for 24 hours after the application
- Avoid using active or aggressive skincare products containing sunscreens, moisturizers, toners/serums and cleansers on the lashes and brow areas.
Acknowledgement and Waiver
I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by Crowned by Catherine. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release Crowned By Catherine from all liability associated with these treatments, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes or brows will stay permed. I understand the aftercare instructions and will do my part to maintain my results from this service (eyebrow lamination or eyelash lift). I understand that there are many factors that may affect the life of the eyelash lift or brow lamination such as water and moisture contact, weather conditions, activities involving exposure to high temperatures, and daily lifestyle choices. By signing below, I verify that I have read and understand the above statements and agree to them.
Signature
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