Consent and Intake Form

I   First Name*   Last Name*   agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional.

   Initial*   I understand that in rare occasions there are risks associated with having artifi cial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. 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, I will contact the certified eyelash extension professional that performed this procedure, and it may be beneficial to have the eyelashes removed.

   Initial*   I understand and agree to the aftercare instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out, and/or impact the time that the lashes will last.

   Initial*   I understand and consent to having my eyes closed and covered for the duration of procedures for 60 - 180+ minutes or more. Times vary depending on the type and number of eyelashes applied.

   Initial*   I agree to inform the eyelash extension professional of the following at time of service:
• Current use of contact lenses, which I may be asked to remove during the procedure.
• Current use of anything such as oil-containing sunscreen or moisturizers around the eyes.

   Initial*   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.

   Initial*   I am 18 years of age or older and consent to the agreement and to the eyelash extension application procedure.