Eyelash Extension Consent Form

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Email

example@example.com

Emergency Contact

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Street Address

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Date of Birth

Date

How did you hear about us?

By completing this form I have agreed to have either traditional or LED/UV eyelash extensions applied and/or removed from my eyelashes. Before my qualified professional eyelash technician can perform this procedure, I understand I must complete this agreement and provide my consent by signing and dating this Consent Form where indicated below.

SOCIAL MEDIA CONSENT

No

MEDICAL HISTORY | Please check any of the following that applies to you

If you checked any of the conditions above or "other" please elaborate in detail, including dates and if it has resolved.

Have you ever had eyelashes extensions before?

If no to the question above, would you like to have a patch test performed? If so, you will need to wait at least 24 hours to see if a reaction occurs. (Note that a patch test does not guarantee that an adverse reaction will never happen, you may develop an allergy at any time)

Have you ever had a lash removal performed before?

Do you use any lash serums or growth enhancers on your natural lashes?

Do you use any medications that might impact your eye health or the application of eyelash extensions or cause photosensitivity ?

If yes to the question above, please specify:

Do you wear contact lenses?

If yes to the question above, do you agree to remove them during the procedure?

Are you currently pregnant or nursing?

Do you have any thyroid conditions or take medication for one?

Have you had any Facial IPL or Laser treatments in the last 21 days?

I, Name:* , certify that the information provided in this form is accurate
and complete to the best of my knowledge. I have read, understood, and answered all
questions truthfully. I have discussed any concerns or questions with the lash technician,
and I have read and understood the aftercare instructions provided to me. I agree to
inform the lash technician of any changes to my medical history, eye conditions, or
concerns. I will not hold the salon or technician responsible for any issues not disclosed at
the time of my service or any adverse effects from the lash extensions procedure.

Name

First NameLast Name

Date

I, Name:* , hereby consent to the application or removal of traditional or UV/LED eyelash extensions by Sublime Beauty. I understand the procedure involves the attachment of individual synthetic, silk, or mink lashes to my own natural lashes using a semi-permanent adhesive and a LED/UV skin and eye safe lamp, or a chemical remover to dissolve the adhesive and manual removal will be completed by my technician.

I understand that the purpose of this procedure is to apply eyelash extensions for cosmetic or personal reasons. I acknowledge that there are certain risks associated with this procedure, including but not limited to eye irritation, allergic reactions, and complications related to the lash extensions.

I understand and agree that if I experience any of the above issues with my lashes I will contact my technician, have the extensions removed immediately and
consult a physician, all at my own expense.

I release Sublime Beauty from all liability for any injury, harm, or adverse reactions claimed by me or anyone on my behalf due to the eyelash extension procedure or the conduct of the eyelash technician.

I understand that in order to have extensions applied to my eyelashes, I will need to keep my eyes closed for roughly 60-180 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes.

I understand that my technician has the right to refuse service if they deem my natural lashes are not suitable for this service or if certain health conditions may complicate the procedure.

I request and consent to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services(s).

I have been provided with information regarding the eyelash extension procedure, its purpose, risks, and aftercare instructions. I agree to follow the aftercare instructions provided by the technician to maintain the quality and longevity of the lash extensions. I have had the opportunity to ask questions, and all my concerns have been addressed to my satisfaction. I understand that the results of this procedure may vary depending on individual factors. I consent to the eyelash extension procedure and acknowledge that the decision to proceed with this procedure is voluntary. I understand that I can withdraw my consent at any time before the procedure begins. This agreement remains in effect for this procedure and any follow-up appointments.

Name

First NameLast Name

Date