Client Consent for Lash Lift

First Name*

Last Name *

Your phone number*

Your E-mail

If you would like to receive our emails.

Date of Birth*

Do you currently have or previously had any eye infections/ disorders?*

YesNo

Have you had a recent eye surgery?*

YesNo

Do you wear contacts? *

Yes (please remove them prior to your service)No

Have you ever had your brows or lashes tinted? *

YesNo

Have you ever had adverse reaction to lash glue and/ or eyelash glue? *

YesNo

Please explain

Do you currently have or previously had used medicated eye drops? *

YesNo

Are you pregnant? *

YesNo

What trimester?

Do you have any allergies? *

YesNo

Please specify

Are you currently taking medications?*

YesNo

Please list all (including over the counter drugs/herbal supplements):

I authorize the technician to perform the Lash Lift, lash tint and/or brow tint procedure. I understand that it is my responsibility to be still during the procedure and to keep my eyes closed during the process unless otherwise advised. Eyes and the skin around them are extremely delicate and can incur damage, including irritation, burning and allergic reaction to the products used to lift the lashes and/ or the tape, anti-wrinkle gel patches or eyelash/brow tint. I have been fully informed as to the methods and procedures concerning the Lash Lift, lash tint and/or brow tint procedure and the risks of the cosmetic procedure I have chosen have been disclosed to me.

If at any time I (or the technician) are uncomfortable with the procedure, I will inform the technician and she will gladly rectify the problem, including ending the session if I (or the technician)wishes. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this treatment have been made. I acknowledge that I have no particular representation or guarantees and I am consenting to the procedure at my own risk. All conditions must be revealed or disclosed by me to the technician regarding my health history, medications being taken and any past reactions to products used or medications were taken. Additional conditions could be discovered during the procedure, which could affect my ability to tolerate the procedure.

I herein sign, release, give up, acquit, and discharge my technician from any claims or damages of any nature.

I release Sweet Serenity Spa from any responsibility for pre-existing conditions I have not revealed or any consequential change to those conditions that arise subsequent to the procedure.

I accept full responsibility for these and any other complications, which may arise or result during or following the procedure(s), which are to be performed at my request.

I, the client herein signed, certify that I have read and had explained to me
and fully understand the above waiver and release form. I certify that I have consulted with the esthetician of Sweet Serenity Spa.
I have provided information regarding my health and medications taken to the best of my knowledge. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind, and fully understand that there might be other unknown risks not reasonably foreseeable at this
time.

I the client herein signed, for the purposes of documentation, hereby consent to “before and after” photographs, which may or may not be used for the purposes of advertising.

By signing below you agree to terms and conditions.

Signature*

Eye Enhancment