Lash Extension Consent Form
Please complete this form to provide your consent and health information before receiving lash extension services.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name and Phone Number
*
Do you have any allergies to adhesives, cosmetics, or skincare products?
*
Yes
No
Please list any allergies (if applicable):
*
Do you have any current or past eye conditions, infections, sensitivities, or recent eye procedures?
*
Yes
No
If yes, please describe:
*
Are you currently wearing contact lenses?
*
Yes
No
I understand that lash extension services are provided by a technician who has completed professional lash extension training and holds certifications in lash application techniques. I understand the risks associated with lash extension services, including irritation, redness, allergic reactions, sensitivity, watering eyes, and discomfort. I confirm that I have disclosed any allergies, medical conditions, eye conditions, medications, infections, or recent eye procedures. I voluntarily consent to receive lash extension services at ALSA Beauty Studio and agree to follow all aftercare instructions provided.
I have read and agree to the consent form above.
*
I have read and agree to the consent form above.
Electronic Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: