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Butterfly Lash Lounge Intake Form

 Intake form for all services.
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    • Yes lash extensions
    • No lash extensions
    • Yes Facial
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    • No Both
    • Yes Both
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    By SUBMITTING THIS FORM, you agree to the following:
    1) I give my permission to receive eyelash extensions, massage, facials,brows or waxing services.
    2) I understand that stylist is not a substitute for traditional medical
    treatment or medications.
    3) I understand that the stylist,or esthetician does not diagnose illnesses or injuries,
    or prescribe medications.
    4) I have clearance from my physician to receive facials and massage therapy, or any other treatments I am receiving.
    5) I understand the risks associated with eyelash extensions, massage therapy, facials, and waxing include,  but are not limited to:
    • Superficial bruising or redness
    • Short-term muscle soreness
    • Exacerbation of undiscovered injury

    • eyelash services; losing lashes, or possible adverse reactions

    I, therefore, release  Butterfly Lash Lounge and the individual stylist or esthetician from all liability concerning these injuries that may occur during the session.
    6) I understand the importance of informing my stylist of all medical conditions and medications I am taking, and to let the stylist know about any changes to these. I understand that there may be additional risks
    based on my physical condition.
    7) I understand that it is my responsibility to inform my stylist, or esthetician of any
    discomfort I may feel during the session so he/she may adjust accordingly.
    8) I understand that I or the therapist may terminate the session at any time.
    9) I have been given a chance to ask questions about the session and my questions have been answered.

    10) I understand all sales are nonrefundable and agree to proceed with scheduled appointments 

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    by signing below, you understand all terms and conditions listed above and those that are on our website. most services are schedule by appointment only and may require a non-refundable deposit. if you are not able to attend your appointment you may reschedule once if you call 24hrs in advance. any appointment cancelled less then 24hrs will require an addtional non refundable deposit to schedule a new service. deposits are non refundable or non-transferable

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