• Lash Lift & Tint - Client Intake Form

  • Client Information

  • Date of birth *
     - -
  • Format: (000) 000-0000.

  • Emergency Contact

  • Format: (000) 000-0000.

  • Treatment Selection

  • Which service(s) are you receiving today?

  • Health History

  • Have you ever had a lash lift and/or lash tint before?*
  • Have you ever experienced an allergic reaction to a lash lift or lash tint?*
  • Do you wear contact lenses?*
  • Are you currently using prescription or over-the-counter eye drops?*
  • Do you currently have an eye infection, stye, pink eye (conjunctivitis), excessive eye irritation, or any other eye condition?*
  • Do you have a history of recurring eye or tear duct infections?*
  • Do you have chronic dry eyes?*
  • Have you had eye surgery (including LASIK) within the past 6 months?*
  • Have you had permanent eyeliner applied within the past 6 weeks?*
  • Have you used Retinol, Retin-A, Tretinoin, or similar Vitamin A products within the past 14 days?*
  • Are you currently pregnant or breastfeeding?*

  • Medical Information

  • Client Acknowledgements

  • I understand there are risks associated with receiving a lash lift and/or lash tint. 

    I understand possible side effects include temporary redness, irritation, itching, watery eyes, discomfort, sensitivity, swelling, or in rare cases, infection or blurred vision.

    I understand that allergic reactions may occur even if I have previously received lash lift or tint services without complications. 

    I understand I have the option to request a patch test before treatment if I have concerns about sensitivity or allergies. 

    I understand my natural lash length, thickness, strength, and condition may affect my final results, and no specific outcome or longevity can be guaranteed.

    I understand that tint results may fade more quickly depending on skincare products, sun exposure, swimming, and skin type.

    I understand that lash lift results typically last approximately 6–8 weeks, although longevity varies by individual.

    I understand that if my esthetician determines it is not safe to perform this service due to a medical condition, irritation, contraindication, or other safety concern, the service may be postponed or refused.

    I understand contact lenses must be removed before the service begins.

    I understand my eyes must remain closed throughout the service to ensure safety. 

    I understand that if I experience unusual irritation, swelling, pain, discharge, or vision changes following my appointment, I should contact MaiBeautyyCo immediately and seek medical attention if necessary. Any medical evaluation or treatment will be at my own expense. 

    By initialing below, I acknowledge that I have read, understand, and agree to all of the information provided above regarding the risks, contraindications, possible side effects, aftercare instructions, and expectations associated with the Lash Lift and/or Lash Tint service.

  • Aftercare Instructions

  • I understand and agree to follow these aftercare instructions to achieve the best possible results: 

    • Be gentle with your lashes. Do not rub, pull, or excessively touch them.
    • Keep lashes completely dry for the first 24 hours.
    • Avoid steam, saunas, hot showers, and swimming for the first 24 hours. 
    • Avoid sleeping directly on your face during the first night whenever possible.
    • Avoid waterproof mascara. Water-based, non-waterproof mascara may be used after the first 24 hours if desired.
    • Avoid oil-based cleansers, makeup removers, and skincare products around the eye area.
    • Avoid harsh facial products around the eyes.
    • Proper aftercare helps maximize the longevity of your lash lift and/or tint.

    I understand that failure to follow the proper aftercare instructions may shorten the life of my lash lift and/or tint.

  • Consent & Release

  • I certify that the information I have provided on this form is true, complete, and accurate to the best of my knowledge. I understand that withholding medical information may increase the risk of complications during or after treatment.

    I understand that while every reasonable precaution will be taken to ensure my comfort and safety, no guarantees have been made regarding the results or longevity of this treatment.

    I voluntarily consent to receive the Lash Lift and/or Lash Tint treatment performed by MaiBeautyyCo.

    I release and hold harmless MaiBeautyyCo and its owner, Mariah Cruz, from liability arising from the ordinary and known risks associated with this treatment, except where prohibited by law or in cases of gross negligence or willful misconduct.

    I understand that this consent will remain valid for future Lash Lift and Lash Tint services unless my medical history changes or this agreement is replaced with an updated version.

    I understand that it is my responsibility to inform MaiBeautyyCo of any changes to my medical history, medications, allergies, pregnancy status, or eye health before future appointments.

    I acknowledge that I have had the opportunity to ask questions regarding this procedure, that my questions have been answered to my satisfaction, and that I fully understand the information provided above.

    By signing below, I confirm that I have read this entire consent form, understand the risks, benefits, contraindications, and aftercare requirements of my treatment, and voluntarily consent to receive the selected Lash service(s).

  • Date*
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