Lash Extension Form

Lash Extension Client Form

Disclosure, Consent Liability & Release
*Signature + Completed Form is Required for Service*
Please fill out & sign all forms prior to or at the time of your appointment.
Name*

FirstLast
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
example@example.com
Phone Number*
Date of Birth*

MonthDayYear
(for birthday goodies)
How did you hear about us?*

ReferralYelpTikTokGoogleInstagramEveryWhereIsQueerOther
If referred, who referred you?
Referrals both receive $10 off services.
Medical History
Do you wear contact lenses?*

YesNo
Have you previously received lash extensions before?*

YesNo
Do you have any known allergies to perm solutions, hair dyes, acrylates or cyanoacrylates?*

YesNo
Do you wish to waive a free patch test?*

I want a free patch testWaive
Consent & Release
I understand:*

There are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes.The eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the client’s natural eyelashes.In order to have the eyelash extensions applied to my eyelashes, I will need to keep my eyes closed for duration of 60-180 minutes and lying in a recline position during the procedure. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes.As part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my lashes, I will contact my technician and if necessary, consult a physician at my own expense.My stylist 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 her immediately.It is my responsibility to advise the stylist of any concerns I may have before these procedures.
Aftercare
By signing below, I agree to follow all aftercare instructions given to me by my stylist to ensure proper and sufficient healing process to achieve the best results.

I understand that if I have any concerns, I will address them with my stylist. I give permission to my stylist, Sophia Luong, to perform the said procedures we have discussed, and will hold her harmless and nameless from any liability that may result from this treatment.

Photography
By signing below, I consent to photos being taken before and after treatments for client notes and documentation that may be used on social media however, client privacy is important to us and any photo used will be cropped appropriately if required.

Studio Policies
By signing below, I certify that I have read, and fully understand, all of SOLUX Face Studio's policies including the booking, late and cancellation, payment and fill policies. I certify that I agree to all terms & conditions upon booking.
LIABILITY RELEASE AGREEMENT

I understand that if I have any concerns, I will address them with my stylist and cosmetologist. I give permission to my sylist, Sophia Luong, to perform the lash extension procedure we have discussed, and will hold her harmless and nameless from any liability that may result from this treatment.

I understand my stylist 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 stylist immediately.

I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures.

I do not hold the lash stylist or SOLUXBeauty LLC., responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

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 have read and agree to the terms above.*

I agree.
Today's Date*

MonthDayYear
Signing Date
Signature*

Clear
By signing, you agree to all terms and conditions.
Thank you for submitting, lash you soon!

SOLUXBeauty | Sophia L. ♡
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Lash Extension Client Form

Medical History

Consent & Release

Thank you for submitting, lash you soon!