New Clients Info.

Full Name:*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Area CodePhone Number

Date of Birth:*

MonthDayYear

TIPS FOR MAINTENANCE AND CARE

To maximize the length of time eyelash extensions remain in place, recommends the following:
Only a Certified Eyelash Extensionist should apply eyelash extensions.
Use only recommended cosmetic products and cleansers (see aftercare instruction) once the extensions are applied.
Do not rub your eyes or pull on the lashes after eyelash extensions have been applied.
Avoid using mascara on a regular basis, as it can shorten the length of time the extensions remain in place.
Do not use waterproof mascara on your eyelash extensions.
After the application, touch-up appointments will be necessary after a few weeks.

NOVALASH Consent Form

1. I understand that using products other than those recommended on my NOVALASH Eyelash Extensions may prevent the Eyelash Extensions from performing as described or expected, and understand that use of such product at my own risk.

2. I understand that there are many variables, application technique, hair growth cycle, use of cosmetics and skin care products, and the overall care maintenance given, that will influence how long my lashes last.

3. I understand that I should not rub my eyes or pull on my lashes after Eyelash Extensions have been applied.

4. I understand that there are risks associated with the application of NOVALASH Eyelash Extensions, including a risk of eye damage and harm to my vision.

5. I understand that using mascara on a regular basis can shorten the length of time my extensions remain in place. I also understand and have been advised not to use waterproof mascara on my NOVALASH Eyelash Extensions.

6. I understand that touch-up appointments will be necessary a few weeks after the application, and that there may be additional fees for these appointments.

7. I understand and acknowledge that by signing this consent form it will act as proof that I have read and understand the terms above and verbalized, for today and any future appointments I have using NOVALASH Eyelash Extensions.

GENERAL HEALTH AND SAFETY RECOMMENDATIONS

Eyelash extensions are not for everyone; prior to application you should notify and discuss with your certified Eyelash Extensionist if you have recently or frequently experienced any of the following:

Unusual sensitivity or skin reaction to Cyanoacrylate-based adhesives.
Moderate to severe allergies in combination with abnormal eye discharge.
Any eye disease or medical condition, such as Conjunctivitis (“pink eye”).
A compromised immune system due to cancer treatment, hepatitis, or advanced Aids.
Any type of cancer
Alopecia
Skin disease
Any metabolic or endocrine disorder
Blunt trauma in or around the eye area.
Intoxication or impaired motor skills due to medications, alcohol, or any other drug.

Never allow uncured cyanoacrylate-based adhesives or removers to contact the eyelid or eyeball. Any uncured cyanoacrylate-based adhesive or remover in contact with the eyelid or the eyeball may cause temporary or permanent eye damage, including temporary or permanent loss of or blurred vision. For any reason, if uncured cyanoacrylate adhesive or remover contacts the eye area, immediately flush with large amounts of water and seek immediate medical attention. Additional information may be found in the Material Safety Data Sheet (MSDS).

Tell us about yourself:

Check the box if you have ever worn lash extensions before.Check the box if you are allergic to Medical Tape.Check the box if you suffer from allergies.Check the box if you have abnormally sensitive eyes.Check the box if you had eye surgery in the past month.

How did you hear about us?

Check all that applies*

I Understand the Health and Safety Recommendations above.I give consent for eyelash extensions as long as all my questions are answered to my satisfaction during my first in-person consultation and/or service.I understand the tips for maintenance above.I have read the above information and will ask your Certified Eyelash Extensionist any questions and/or concerns you may have.

I have read the above information and understand it. The application procedure as well as potential benefits, risks, and alternative have been explained to me by the NOVALASH Certified Lash Extensionist and I have had all my related questions satisfactorily answered by the Extensionist. I hereby freely consent to the application and accept the risks and possible complications of such application.

Name*

First NameLast Name

Date*

MonthDayYear

Signature*

EYELASH EXTENSION CONSENT FOR PROCEDURE

1. I agree to only use recommended products on my Eyelash Extensions.

2. I understand that there are many variables, including technician expertise, hair growth cycle, use of cosmetics and skin care products, the overall care given, that will influence how long my Eyelash Extensions remain in place.

3. I acknowledge that I should not rub my eyes or pull on my lashes after Eyelash Extensions have been applied.

4. I understand that if a certified eyelash extensionist does not apply eyelash extensions properly, there is risk of eye damage and harm to my vision.

5. By reading this have been advised that using mascara on a regular basis can shorten the length of time my extensions remain in place. I have also been advised not to use waterproof mascara on my eyelash extensions.

6. I understand that touch-up appointments will be necessary a few weeks after the application, and that there may be additional fees for this procedure.

CONSENT FOR PROCEDURE

1. I understand that eyelash extensions are semi-permanent. I understand that the lasting beauty and effect are highly variable and are dependent upon, among other things the skill and expertise of the Certified Eyelash Extensionist, my normal hair growth cycle, my use of cosmetics and skin care products, and my adherence to the instructions for maintenance and care.

2. I have fully read and understood all of the information on this form. I understand that I will be given an opportunity to ask questions about the products, the application procedure, and any risks and hazards involved. I understand that any uncured cyanoacrylate-based adhesives or removers in contact with my eyelid or eyeball can cause temporary or permanent eye damage, including loss or blurred vision. My Certified Eyelash Extensionist will fully explain the procedure and answer any questions to my satisfaction.

3. I do not have any condition as noted above, or any other condition, which I am aware, that would affect the general use or application of eyelash extensions.

4. I understand that touch-up appointments may be necessary for an additional fee.

COMPANY POLICY

• Our time is very valuable to ensure that we can provide all of our clients the best look possible, for this reason, we please ask that you be on time to all of your appointments. Please try to arrive at least 5 to 10 minutes prior to your scheduled time to ensure you receive your full appointment time.

• In the event that you should be tardy we please ask that you be considerate and call to inform us of your situation so we may take necessary action or make special arrangements. Please be aware that if you are 15 minutes or more overdue to your appointment you will need to reschedule your appointment, NO EXCEPTIONS.

• In the event that you need to cancel or reschedule your appointment we ask that you please notify us within 24 BUSINESS HOURS before your appointment.

WE RESERVE THE RIGHT: to charge a cancellation fee when canceling or rescheduling “the day of” your appointment of the schedule services on NO-SHOWS.

• ALL CLIENTS MUST HAVE A CREDIT CARD ON FILE PRIOR TO BOOKING AN APPOINTMENT FOR ANY SERVICE TO GUARANTEE YOUR APPOINTMENT**

The satisfaction of our clients is our main priority. We offer prompt solutions to any problems or concerns that may occur.

Thank you for your business, in advance.

Name*

First NameLast Name

Date*

MonthDayYear

Signature*

PRIVACY POLICY

We value your privacy. We do not disclose any information you provide, and never share it with other entities outside Nouvelle Lashes. Your information is used ONLY for internal informational purposes.

Nouvelle Lashes Client Information