Eyelash Extension Consent Form
Thank you for choosing Yessy.lashess. I am looking forward to a long and lengthy communication.
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about yessy.lashess?
Instagram
Facebook
TikTok
Friend
Other
Health History | Please check any of the following that applies to you
Allergy to adhesives, band aid or medical tape
Allergy to surgical glue
Seasonal allergies
Allergy to glycerin
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Eye lift
Eye surgery within last 6 months
Other
Are you wearing eye contacts and are you willing to remove them before the procedure?
Yes
No
Have you ever had eyelashes extensions before?
Yes
No
Have you ever had any allergies to lash extensions or the lash adhesive? If so, please state the reaction.
Do you understand that eyes must be closed during the procedure? and if they are not it can lead to a chemical burn?
Yes
No
Please let me know during the process if anything bothers you or feels like it's touching your eye
Will do
Do you understand that there are no refunds for this service, due to time and products being used.
Yes, I understand
No, I do not understand and I will not be moving forward with the appointment
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.
I consent to "before and after" photographs for the purpose of documentation, potential advertising and promotional purposes.
I, 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.
Date
-
Month
-
Day
Year
Date
Client Signature
I understand the above policies
I understand that if I pick off my lashes the lash artist is not responsible for any damages.
I understand the after care
Continue
Continue
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