Lash Lift Consent Form

1

Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Have you had a lash lift before?* This field is required.

Yes

No

5

Do you have any allergies or sensitivities to adhesives, dyes, or cosmetics?* This field is required.

Yes

No

6

If yes, please specify:

7

Medical history / contraindications

8

Current medications

9

Eye conditions

10

Pregnancy or breastfeeding status* This field is required.

Yes

No

Prefer not to say

11

Prior reactions to beauty products* This field is required.

Yes

No

12

Please read and acknowledge the following:* This field is required.

I understand the nature and purpose of the lash lift procedure.

I have disclosed any allergies, sensitivities, or medical conditions relevant to this treatment.

I understand the possible risks and side effects, including irritation or allergic reaction.

I agree to follow aftercare instructions provided by my technician.

13

Consent statement* This field is required.

I understand that the technician may stop or decline treatment if safety concerns arise.

14

Signature (please sign to provide your consent)* This field is required.

15

Date* This field is required.

Date