LASH CONSENT FORM

Name

First Name

Last Name

Phone

(###)

###

####

I understand that lash extension/lift services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could results in stinging, burning, blurry vision, and potential blindness should adhesive enter the eye or an allergic reaction occur.

I understand

I understand that some irritation, itching, or burning may occur on the skin if the bonding agent comes into contact with it.

I understand

I understand that if the bonding agent comes into contact with my eye, my eye will be flushed with water and I will be assisted in seeking medical attention immediately.

I understand

I understand that this is a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch-up or "fill" appointments necessary to maintain the achieved look by replacing lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks.

I understand

I understand that while every attempt will be made to provide me with the length and fullness I have chosen, my final result may not be what I initially envisioned.

I understand

I have detailed to my lash technician any allergies or health conditions I may have.

I have

I have not

I consent to "before and after" photographs for the purpose of documentation, potential advertising and promotional purposes.

I consent

I do not consent

I understand that if I have any concerns, I will address these with my lash extension specialist. I give permission to my lash extension specialist to perform the lash extension procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my lash extension specialist 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 lash extension specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. 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 do not hold the lash extension specialist, whose signature appears below, 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.