DLASHSTUDIO_01 Liability Waiver & Consent
Client Information
Full Name
Date of Birth
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Day
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Year
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Medical History / Health Questionnaire
Health Questionnaire
Sensitive eyes
Dry eyes
Watery eyes
Contact lens wearer
Seasonal allergies
Eye infection within the last 30 days
Skin sensitivities
Have you previously had eyelash extensions?
Yes
No
Last set received
Any reactions or complications?
Yes
No
If yes, explain
Desired set: Mascara or natural look?
Desired Lash Set
Classic
Hybrid
Volume
Mega Volume
Wispy
Cat Eye
Kitten Eye
Doll Eye
Open Eye
Additional notes
Consent & Acknowledgment
Initial - I understand that I may experience temporary redness, irritation, watering, or sensitivity after the service.
Initial - I understand that eyelash extension application requires my eyes to remain closed during the entire procedure.
Initial - I understand that allergic reactions to products used during the service are possible.
Initial - I agree to disclose any known allergies, sensitivities, medical conditions, or eye conditions prior to the service.
Initial - I understand that proper aftercare is necessary to maintain my eyelash extensions.
Initial - I understand that results may vary based on my natural lashes and lifestyle.
Initial - I understand that as a beginner lash artist, the appointment may take longer than a standard lash appointment.
Initial - I agree to notify the lash artist immediately if I experience discomfort during the service.
Initial - I understand that no guarantees are made regarding retention or longevity of lash extensions.
Liability Waiver
I voluntarily consent to receiving eyelash extension services. I understand the risks associated with eyelash extension application, including but not limited to eye irritation, allergic reactions, redness, swelling, discomfort, and damage to natural lashes if aftercare instructions are not followed. I release and hold harmless the lash artist, business owner, and affiliates from any liability, claims, damages, or expenses that may arise from the eyelash extension service, except in cases of gross negligence. I certify that all information provided on this form is true and accurate.
I certify that all information provided on this form is true and accurate
*
I certify
Photo Release (Optional)
I authorize the lash artist to take before-and-after photos of my lashes for educational, marketing, and social media purposes.
I do NOT authorize photos to be used.
Client Initials
Aftercare Instructions - No water, steam, or excessive sweating for 24–48 hours. - Do not rub or pull extensions. - Avoid oil-based products around the eyes. - Clean lashes regularly with approved lash cleanser. - Brush lashes daily with a clean spoolie.
Client Signature
Client Signature Date
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Month
-
Day
Year
Date
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