Eyelash Lift, Brow Lamination & Tint Intake Form

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Have you had an eyelash lift in the past?*

Yes, in the pastNoYes, in the last 6 weeks

Have you ever had an allergic reaction to hair color/eyelash tint?*

YesNoNever used brow/lash tint before

List any allergies you have:

List any illnesses, medical conditions, or medical treatments you have recently received that would prohibit or compromise the process and retention of this eyelash lift:

I consent to having my eyes closed and covered for the duration of the 45-90 minute procedure.*

YesNo

I wear contacts

YesNo

I, undersigned, accept the following statements:*

I agree to have an eyelash lift, brow lamination and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm, brow lamination or eyelash tint by my technician.I understand there are risks associated with having an eyelash perm, brow lamination and/or eyelash tint.I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur.I understand that some mild but normal symptoms may occur with the brow lamiation depending on the sensitivity of my skin during the procedure and will subside in 24 hours. These symptoms may include: mild tingling, slight redness due to brushing the hairs, slight warmth in the area.I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.I understand that even though my technician perms the lashes/brows using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes/brows or require a physician’s follow-up care.I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes/eyebrows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told.

I agree to the following Post- Lash Lift:

No water can come in contact with the eye area for 24 hours after the application.Avoid makeup such as mascara, eyeliner or brow pencil for the first 24 hours.Avoid using oil containing sunscreens, moisturizers and cleansers on lashes for the first 24 hours.

Acknowledgement and Waiver

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service.
This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I give permission to my esthetician/technician to perform the eyelash lifting procedure we have discussed and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician/technician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetician/technician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician/technician, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed today.This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement.I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. I understnad that technicain is not reliable for any damnage to personal belonging due to any accidental situaions. ie. wax, adheavice, oil, etc.

CANCELATION POLICY:

• Cancelations within a 24-hour notice of the service, client will be charged 50% of the service scheduled.

• Please, if client has any symptoms of coughing, sore throat, extreme runny nose, or fever, client MUST cancel 24 hours before client's appointment. If client does not give 24-hour notice of cancellation with any of these symptoms, client will be charged 100% of the service and reported as a "no show". If symptoms start after the 24-hour policy, please text LLB immediately and we will reschedule the appointment.

• Clients that are more then 15min late will be charged the cancelation fee (50%) and asked to reschedule for quality of service.

•ANY NO-SHOW clients will be charged 100% cost of service scheduled.

• Second time "NO CALL NO SHOW" will no longer be able to book with LBB.

Date*

Date

Signature*