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Lash Extension Consultation Form
Client Information and Consent
Name
First Name
Last Name
DOB
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Occupation
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
Format: (000) 000-0000.
Email
example@example.com
Rows
Yes
No
Is this your first time having lash extensions?
Do you wear contacts ?
Do you often rub, pull or pick your lashes for any reason?
Do you have a severe eye illness or are you being treated for an eye injury?
Are you able to lay on your back for 2 3 hours to have your lashes applied?
Are you pregnant?
Are you allergic to adhesives (glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads that may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur?
I agree and understand that my lash technician will have no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. The lash technician does offer patch tests to those that are not sure if they are a good candidate and will help to discuss options. I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks.
Client Initial
Client Information and Consent Continued
By signing this consent form, you acknowledge that pictures or videos may be taken during your session for potential use on our social media platforms. These visuals serve to showcase the quality of our services and may include before and after images. Please communicate your preferences and we will respect your wishes
Client Initial
I acknowledge and understand that the studio doesn't offer refunds. The lash technician will do their ultimate best to provide a service experience to meet your satisfaction and expectations to love your lashes every appointment.
Client Initial
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
Client Initial
Eyelash extensions require on-going maintenance (similar to a nail service). Refills are recommended approximately every 2 weeks. I understand if I go beyond this recommended time it may result to an incur (higher) service cost as a fullset
Client Initial
I have read and understood the information provided in this consent form. By signing below, I voluntarily consent to receive the lash extension service described above.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
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