Full Name*

Name Last name

Cell phone number*

Area Code Phone Number

Date of Birth*

Date

Age*

Email*

example@example.com

Are you under the influence of alcohol or drugs*

Yes No

Is this your first time having Eyelash Extensions?*

Yes No

Are you having lash extensions applied for?*

Special occasion Daily wear

Do you wear Contacts? _*

Yes No

Do you have ANY make up around your eyes today? _*

Yes No

Do you often rub, pull or pick your lashes for any reason?*

Yes No

Do you have , or are you being treated for any eye illness or injury?*

Yes No

Please list any eye drops or eye medication you are currently using

Are you able to lay on your back for 2+ hours to have your lashes applied?*

Yes No

Will you be able to keep your eyes completely closed for up to 2+ hours? ?*

Yes No

Are you pregnant? ?*

Yes No

What other products do you currently use around your eyes? ( eye creams, oinments, lash growers, etc.

PLEASE NOTE USE OF OIL BASED PRODUCTS AROUND EYES SHOULD BE DISCONTINUED AFTER YOUR EYELASH EXTENSION SERVICE. It is also recommended to avoid all oil based products around your eyes for as long as you wear your lashes. Oil based products, waterproof mascaras and liners will loosen the adhesive and your lashes will not last long.*

Please initial and date you read and understand the above.

For longevity we recommend not to use mascara ( you're lashes will look so glamorous you won't feel a need to), however if you must, be sure it is oil free and remove it daily with an oil free wash. We recommend our aftercare bags or you can may use a oil free face wash at home.*

Please initial and date you read and understand the above.

How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most and it is important to refrain from sleeping on your stomach for the first 4 days after your service to allow the adhesive to set properly.*

Left Side Stomach Back Right Side

Are you allergic to adhesives ( glues, tapes, band aids, etc)? This service may use adhesives tapes, glues and gel pads thaty may cause an allergic reaction. We use a medical grade, formaldehyde free glue, but allergies may still occur.? _*

Yes No

Have you had Lasik Surgery in the past 4 months? Eyes may have sensitivity to eyelash extensions and products used for prepping the eye area (gel pads, glues, etc.). _*

Yes No

Are you currently taking Thyroid Medications? Thyroid medications or Thyroid Conditions may not last long due to either of these.. _*

Yes No

Blephoroplasty or other eye condition or surgery in the last 6 months? Blephoroplasty , eye surgery or conditions may have sensitivity to eyelash extensions and products used. Consult your doctor first and ask if it's safe for you to have this service.*

Yes No

Do you wear Contact Lenses:Contact Lenses MUST be removed prior to eyelash extensions procedures. Products may get underneath the contact lens and cause an abrasion or scratching.*

Yes No

Do you have Extremely Oily skin and or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, merely it may cause them to fall out quicker.*

Yes No

X
Step 1 - Consultation with your Lash Extension Expert to insure this service is right for you and explain to your before, during and after experience thoroughly.

Step 2 - Select the style of lashes you would like, to cover length, fullness and shape. If you're unsure, your lash tech will be happy to recommend what's best for you and your lifestyle.

Step 3 - Get Lashed Up!

Step 4 - Rebook for your refill in approx 2 to 3 week.
Just a few more things! This is to insure a great service and outcome for you.

I understand that eyelash extensions require ongoing maintenance ( similar to a nail service). Refills are recommended approx. every 2 to 3 weeks. I understand if I go beyond this recommended time it may need a full set.*

Initial

I acknowledge and understand that ALARIS LUXE doesn’t do Refunds. The lash tech will do the best that she can to satisfied the customer.*

Initial

I will seek medical care (at my own expense) and contact my lash technician immediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure.*

Initial

I agree and understand that the lash tech has no way of knowing if the client is allergic to some of the products or materials being use in any procedure.*

Initial

I grant permission to use my before and after photos for marketing or examples of my technicians work.*

Yes No

Please sign that you are aware Specialist has sanitized hands and implements. I assume full responsibility for myself and anybody in my care. I am not sensitive to acrylic fingernails or nail polish. I have notified my eyelash specialist of any and all health complications that I may have, and have provided said specialist with a list of my medications and allergies. I will give a minimum of 36 hours notice for a cancellation so that specialist can book another client for the time that was reserved. If I don’t not give 24 hours notice for a cancellation or rescheduling, I will pay a fee of 40% to compensate for the specialist’s time. If I cancel or reschedule 4 hours before my appointment , I will pay a 75% cancellation fee to compensate specialist for their time. If I do not call to cancel an appointment and fail to show up to said appointment, then I am aware that I will be charged up to a 75% fee of the service. I am aware that on rare occasions, an allergy may occur between myself and the lash adhesive, where irritation, redness, or swelling may take place. If this should happen, I will not hold the specialist who applied my eyelash extensions liable. I have reviewed my original Client Intake Information Form and confirm that I have disclosed all accurate information to the best of my ability. I also have the right to request a copy of my Client Awareness Form, as well as a copy of my AfterCare Form. For any and every additional eyelash extension appointment I will review these forms and either confirm that the information is still up to date, or I will makw my lash technician aware of any changes. I understand that to insure the longest lasting lashes possible, I should avoid rubbing and pulling on my eyelashes. I understand that mascara of any kind could break down the lash adhesive, resulting in a shortened lash life. I am aware that the lash adhesive needs at least 24-48 hours to fully cure and that I MUST avoid water, steam, tears, eye drops, or any wet products in, on, or around my eyes and lashes during this time period. I am fully aware that moisture on my lashes within 24-48 hours after my eyelash extensions have been applied may result in irritation to my eyes or eyelids and could compromise the appearance and/or the longevity of the lashes. I understand that any products, such as make-up removers, moisturizers, make-up, or eye creams, on or around my eyelash extensions may compromise the longevity of the lashes. If I fail to follow these after care instructions, I will not render my eyelash specialist or Alaris Luxe responsible for any dissatisfactory results.*

Initial

*

By signing below, I verify that I have read and understand the above statemetns and agree to them. Thank you for the time you took to read, understand and agree to our consent form..

Sign date*

Date

Client signature*

Clear

Eyelashes extensions consent form.

The following conditions are not suitable for eyelash extensions.Possible adverse reactions are listed below each condition.

Beautiful Lashes can put a serious swagger in your step! We use only high quality medical grade glue and lightweight lashes to give you a glamorous yet natural look. Here is what you'll experience today.