Lash Lift Consent Form

Juel Beauty Bar

Lash Lift Consent Form
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever had a lash lift or tint before?*
Do you have any allergies, especially to adhesives, latex, or beauty products?*
If yes, please list your allergies:
Have you ever had an allergic reaction to hair color/eyelash tint?
Do you have any of the following conditions? (Select all that apply)*

Other
Are you currently pregnant or breastfeeding?*
Please list any medications you are currently taking:
I agree to the following eyelash lift care and maintenance instructions:

•Be gentle with your lashes; no rubbing or pulling.
•Do not get your lashes wet for the first 24 hours.
•Use of sauna/steam is possible after 24 hours, but may weaken the effect of the lift.
•Swimming should be avoided for at least 24 hours.
•Do not use harsh products on your eyes or lashes.
•Avoid oil based makeup and cleansers, and waterproof mascara.
By signing below, I confirm that the information provided is accurate and I consent to receive the lash lift procedure. I understand the risks and agree to proceed at my own risk.*
Should be Empty:

Juel Beauty Bar