• Eyelash Extension Consent & Liability Form

    Eyelash Extension Consent & Liability Form

    Thank you for choosing Glam.WKim Studio. We are looking forward to a long and lengthy communication.
  • Format: (000) 000-0000.
  • Health History | Please check any of the following that applies to you
  • Have you ever had eyelashes extensions before?
  • Yes/ No patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)
  • I voluntarily consent to receive eyelash extension services. I understand that while every precaution is taken to ensure my safety and satisfaction, there are risks associated with this service, including but not limited to eye irritation, redness, allergic reactions, sensitivity, discomfort, or premature lash shedding.

    I confirm that I have disclosed any relevant medical conditions, allergies, eye infections, recent eye surgeries, or medications that may affect this service. I understand that withholding this information may increase the risk of complications.

    I agree to follow all aftercare instructions provided by my lash technician. I understand that failure to follow aftercare recommendations may affect the longevity of my lash extensions and is not the responsibility of the technician.

    I release and hold harmless Gla.WKim, its owner, and affiliates from any liability for adverse reactions, injuries, or damages resulting from this service, except in cases of gross negligence or willful misconduct.

    By signing below, I acknowledge that I have read, understood, and voluntarily agree to the terms above. I authorize the lash technician to perform the eyelash extension service.

  • Please agree to the terms and conditions
  • Date
     - -
  • Lash technician First Name and Last Name

    Kimberly Moua

  • Lash Technician Signature

  • Kim Moua

  • Should be Empty: