• Phases Esthetics Lash Lift and Tint Consent Form

    Complete your client details, treatment history, and consent preferences for today’s visit.

  • Client Information

  • Format: (000) 000-0000.
  • New or Returning Client*
  • Has anything changed since your last visit?*
  • Which lash service are you receiving today?

  • Lash Lift & Tint Contraindications

  • Do you currently have an eye infection or irritation?*
  • Have you had eye surgery or LASIK within the past 3 months?*
  • Have you had a previous allergic reaction to lash lift, tint, or adhesive products?*
  • Eye & Lash Health (Select all that apply)*
  • Are you pregnant or breastfeeding?*
  • Retinoid use*
  • Accutane in last 12 months*

  • Lash Lift & Tint Risks, Contraindications & Aftercare Acknowledgment

  • I understand that a lash lift and/or lash tint is a cosmetic treatment and that results may vary from person to person. I understand there is a possibility of temporary redness, irritation, watering of the eyes, or an allergic reaction. I have disclosed all relevant medical conditions, medications, and allergies. I understand that hormonal changes, medications, and previous cosmetic procedures may affect my results. I agree to follow all aftercare instructions, including keeping my lashes dry for the first 24 hours after treatment. Failure to follow aftercare instructions may reduce the longevity of my results. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction.

  • Consent & Agreement

  • Photo Consent*

  • Consent to Treatment

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: