Lash Lift + Tint

Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

How did you hear about us?

Have you had a lash lift and/ or tint before?

If yes when was your last appointment?

Date

Please select if you have any of the following conditions:

Do you have any allergies, especially to adhesives, dyes or eye products?

List allergies

Have you had any recent procedures to eyes/ face?

If yes what procedure(s)?

I agree to the following aftercare terms:

Consent and Agreement:

I certify that the information I have provided is true and complete to the best of my knowledge. I have disclosed any known medical conditions, allergies, medications, eye conditions, recent procedures, or other circumstances that may affect my eligibility for this service. I understand the nature of the lash lift and tint procedure, including its potential risks, benefits, limitations, and expected results.

I acknowledge that no guarantees or warranties have been made regarding the outcome or longevity of the service.

I voluntarily consent to receive a lash lift and tint service at Wellness at Wildwood, to be performed by a licensed and qualified professional. I understand that I may withdraw my consent or request that the service be stopped at any time. I agree to follow all aftercare instructions provided and understand that failure to do so may affect my results.

I release and hold harmless Wellness at Wildwood, its owners, employees, and independent contractors from liability for any adverse reactions, complications, or unsatisfactory results that may occur, except in cases of gross negligence or willful misconduct. By signing below, I acknowledge that I have read, understood, and agree to the terms of this consent and authorize the licensed professional at Wellness at Wildwood to perform the requested service.

Signature

Lash Lift and Tint