Lash Extension Client Release- Routine Beauty 2022

  • Routine Beauty

    Lift Consent Form 2022

  • Your Personal Info

  • Format: (000) 000-0000.
  • Birthdate*
     - -

  • *you must be 18 or over to receive services

  • Have you ever had a lash or brow lift before?*
  • Lash and brow lifts require medical tape and adhesives that may contain acrylic, cyanoacrylate or latex. Are you allergic to either of these?*
  • Do you have any other known allergies?*
  • Do you have frequent eye irritation, itching, or watering eyes?*
  • Have you had eye surgery in or around your eyes in the last six months?*
  • Do you wear contact lenses? If yes, please arrive at your appointment without contact lenses and do not wear them for 2 hours following the appointment.*
  • Please check any of the following that might apply to you:
  • The following drugs may cause premature lash loss, leading to dissatisfaction with your lash service. Are you taking any of the following:

  • Your Skincare

  • Please check all products you use on a regular basis:
  • Have you had chemical peels, laser or microdermabrasion in the last month?*
  • Do you use Retin-A, Renova, Adapalene Hydroxyl Acid or Retinol/vitamin A derivative products? (please discontinue use of vitamin A products 7 days prior to your brow lift to avoid skin redness or irritation)*
  • Have you used these in the last 3 months?
  • Have you used an acne medication?*

  • Your Photo Release

  • -I hereby grant Routine Beauty permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

    -I understand and agree that all photos will become the property of Routine Beauty and will not be returned.

    -I hereby irrevocably authorize Routine Beauty to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.

    -I hereby hold harmless, release, and forever discharge Routine Beauty from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

    I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

  • I ACCEPT

  • Your Agreement & Consent

  • Please read the following statements and initial next to them. Your initials confirm you have read, agree to and understand the information and policies outlined.

  • These aftercare instructions include:

  • DO:

    • Keep the area completely dry for the first 24 hours  

    • Sleep flat on your back and avoid misshaping the lashes & brows

    • Avoid extremely hot showers, saunas, and steam rooms

    • Use black or clear mascara on your lash lift daily (never waterproof!!!)

     

  • DO NOT:

    • Pick, pull or rub your lashes, eyes, and brows

    • Wear false eyelashes

    • Curl or trim your lashes

  • I release my technician or studio, Routine Beauty, from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application, using tools and products the technician has been properly trained to use. There is no guarantee for the bonding time of eyelash extensions. I understand that there are many factors that may affect the life of the eyelash extensions, such as: proper aftercare, water, moisture contact, weather conditions and activities involving exposure to high temperatures.

    This agreement will remain in effect for this procedure and all future procedures conducted by the certified lash extension professional. I understand this agreement is legal and binding.

  • Date:*
     / /

  • COVID 19 Screening and Info:

  • 1. Have you had a fever in the last 24 hours of 100°F or above?*
  • 2. Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath?*
  • 3. Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus type symptoms?*

  • COVID-19 is a highly contagious virus that spreads from person to person. In addition to long-held and explicit sanitation measures this business has always adhered to, new preventative measures have been put in place to further reduce the spread of this novel coronavirus. However, these best practices still offer no guarantee regarding your potential risk of being infected.

  • Consent for Treatment

  • I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

  • Date*
     / /

  • Thank you for taking time to complete this form in it's entirety! 

  • Should be Empty: