VENUS MEI LLC

1

I agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched.* This field is required.

Yes

No

2

By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional.* This field is required.

Yes

No

3

I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions to or removed from my natural eyelashes.* This field is required.

Yes

No

4

I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact eyelash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed.* This field is required.

Yes

No

5

I understand and consent to having my eyes closed and covered for the duration of approximately 1-3 hours. Times may vary depending on the type and number of eyelashes applied.* This field is required.

Yes

No

6

I am informing the certified eyelash extension professional of the following conditions by marking with a check:* This field is required.

Current use of contact lenses which I may be asked to remove during the procedure

Current use of medication of any kind, prescription or over-the-counter, including birth control.

Current allergies or sensitivities

History of recurrent eye or tear duct infections

Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions

Allergic to latex

None

7

I agree to the following eyelash extension follow-up and maintenance instructions:* This field is required.

No waterproof mascara

No oil based products around the eye area

No water can come in contact with the eye area for 24 hours after the application

No tinting or perming of eyelash extensions

No pulling or rubbing of the eyelash extensions

Should any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact

All of the above

8

This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. 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 am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.

9

DATE:* This field is required.

Date

10

PHONE:* This field is required.

11

CLIENT FULL NAME:* This field is required.

12

CLENT SIGNATURE:* This field is required.

13

Email

example@example.com