Eyelashes extensions consent form.
Although every precaution will be taken to ensure your safety and wellbeing before, during and after yourlash extension application, please be aware of the following information and possible risks.
full name
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Name
Last name
Date of Birth
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Month
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Day
Year
Date
Age
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Cell phone number
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Area Code
Phone Number
Email
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example@example.com
Is this your first time having Eyelash Extensions?
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Yes
No
Do you wear Contacts? _
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Yes
No
Do you often rub, pull or pick your lashes for any reason?
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Yes
No
Do you have , or are you being treated for any eye illness or injury?
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Yes
No
Please list any eye drops or eye medication you are currently using
What other products do you currently use around your eyes? ( eye creams, oinments, lash growers, etc.
PLEASE NOTE USE OF OIL BASED PRODUCTS AROUND EYES SHOULD BE DISCONTINUED FOR 48 HOURS AFTER YOUR EYELASH EXTENSION SERVICE. It is also recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long.
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Please initial and date you read and understand the above.
For longevity we recommend not to use mascara ( you're lashes will look so glamorous you won't feel a need to), however if you must, be sure it is oil free and remove it daily with an oil free wash. We recommend our eye wash, or you can may use Sterild or Occusoft ( available at most drug stores).
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Please initial and date you read and understand the above.
Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.? _
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Yes
No
I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks. _
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Initial
I grant permission to use my before and after photos for marketing or examples of my technicians work.
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Yes
No
I am a beginner and my goal is for you to leave with lashes you love! Meaning I might take a little longer to do a set. If you don’t like your lashes, I do give free removals. I understand it’ll take longer depending on sets.
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Yes
No
I release my certified lash technician from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme tempatures, natural eyelash shedding and other factors. The technician ( along with my consent form and consultation) will decided if I am a good candidate for this serive to the best of their ability.
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Initial
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By signing below, I verify that I have read and understand the above statemetns and agree to them. Thank you for the time you took to read, understand and agree to our consent form..
Sign date
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Month
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Day
Year
Date
Client signature
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Submit
Submit
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