𝐆𝐥𝐚𝐦𝐦𝐞𝐝 𝐁𝐞𝐚𝐮𝐭𝐲
Client consent form Lashes
Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever had lash extension before ?
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yes
No
If you said yes, what do you like or you don't like about the service?
Do you use eye contacts ?
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yes
No
Have you ever experienced any negative reaction (allergies/ sensitive) before any lash or brow services?
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yes
No
If you said yes, what are the details?
Do you take any medication that causes you Dryness or itching?
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yes
No
If you said yes, what is?
Do you suffer from any health condition that can cause sensitive in your skin or eyes zone?
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yes
No
If you said yes, what is?
Lash extension require medical tape, pads and adhesive that contains Acrylic nails, Aloe vera, Latex, Mascara black pigment. Do you present any allergies for Acrylic nails, Aloe vera, Latex, Mascara black pigment?
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yes
No
don't now
I agree
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First Name
Last Name
Date
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Month
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Day
Year
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I consent and agree to have eyelashes extension applied to my natural lashes and/or removed by the License eyelash technician understand that in rare occasion, there are risks associated with having artifical eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases, as part of the procedure eye irritation and discomfort may occur. I agree that if I experience any of these conditions that I will contact the License eyelash technician that performed this procedure and may be beneficial to have the eyelashes removed as soon as possible.
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Please Select
YES
NO
I understand and consent to having my eyes closed and covered for the duration of approximated 1-3 hour procedure. Times may vary, depending on the type and number of eyelashes applied.
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Please Select
YES
NO
𝘊𝘢𝘯𝘤𝘦𝘭𝘭𝘢𝘵𝘪𝘰𝘯/ 𝘙𝘦𝘴𝘤𝘩𝘦𝘥𝘶𝘭𝘦
*A NON REFUNDABLE $15 deposit will be required to be able to reserve your appointment, if you would like to reschedule you will have to notify me 48h before, so that you can schedule another day/time. If you do not notify me before 48h, the deposit WILL BE LOST and another deposit will be required to schedule.
I agree
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First Name
Last Name
Date
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Month
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Day
Year
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I understand and agree to the after-care instructions provided by the License eyelash technician for the use and care of my eyelash extensions. I realize that accept that failure to adhere to these instructions may cause the eyelash extensions to fall out and/or decrease the longevity of the lashes.
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Please Select
YES
NO
I agree
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First Name
Last Name
Date
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Day
Year
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