Pinkys Beauty Box Eyebrow and Lash Tint Consent and Release

Pinkys Beauty Box Eyebrow and Lash Tint Consent and Release

Statement of consent and release
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Please agree to the terms and conditions*

I understand that tinting lashes or brows has some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, and blurry vision.I understand that if the tinting agent, developer, or mixture of both accidentally comes into contact with my eye, my eye will be flashed with water and medical attention may be required.I understand that some irritation, itching or burning may occur to the stain which comes in contact with the tinting agent.I understand that there may be some residual dark staining left on the skin following theTinting process of either my lashes, brows or both. This will fade and go away within a short time.I understand that, while every attempt will be made to provide me with my chosen color, everyone hair absorbs color differently and my final results may not be the color I initially wanted.Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4weeks,I understand that over the course of several weeks, the tint will gradually lighten and fade.I agree to have eyebrow/eyelash tint applied by a technician at Pinkys Beauty Box. If any problems arise I will contact Pinkys Beauty Box, 808.670.0136 or pinkysbeautybox@gmail.com.I understand that there will be a charge of 50% of my service fee for giving less than 24 hr notice to cancel or reschedule my appointment.I agree to pay 50% of my service fee if I no-show to my scheduled appointment.This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional.I have read and fully understand this entire consent form.I agree that by reading and signing this consent form, I will release Pinkys Beauty Box from any claims or damages of any nature.
Health History | Please check any of the following that applies to you:*

Allergy to adhesives band aid or medical tapeAllergy to surgical glue or nail glueSeasonal allergiesEye illness or injuryAllergy to glycerinBlepharitis (inflamed eyelids)Permanent eye-makeupDrugs that can cause temporary hair lossEye liftMajor surgery within last 120 daysNone of the aboveOther
This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified technician. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all the information in this agreement. I am 18 years of age/or older and consent to the agreement and to the eyelash extension application procedure.
Client Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty: