Lash Lift & Tint Consent Form

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Birthday *

Date

I consent to the eyelash lift, tint, and/ or eyebrow tint. I am waiving my right to have a patch test done prior to this appointment or have already received a patch test from my technician at Scarlett's Lash Boutique and have no allergic reaction, itching, or irriation. I understand that although the eyelash lift and tint product is not directly applied to the skin, product may come in contact with the skin or eyes during the procedure. Scarlett's Lash Boutique is not responsible for any allergic reactions, medical conditions, injuries, that take place during or after your eyelash lift, tint, or eyebrow tint. However, in the case of any reaction, we request you notify SLB immediately for documentation and recommend you seek medical advice immediately from a physician.

I have not worn waterproof mascara within the past 48-hours. I am aware I have to remove my contact lenses prior to this service.

Please note, SLB is unable to determine the exact results based on a variety of outside factors (previously lifted lashes at another Salon, lash growth).

Do you wear contact lenses? *

Yes No

Are you pregnant? *

Yes No

Do you currently have problems laying flat? *

Yes No

Do you have any known allergies? *

Do you require a patch test of product prior to treatment? *

Yes No

Do you have or had any of the following: *

Allergies Eye Conditions Reaction to hair color Asthma or Respiratory problems None of the above

Have you ever had your eyelashes lifted before? *

Yes No

Are you using any prescription or over the counter eye drops or medication used for the eye, lid, or skin near the eyes? If yes, what? *

Have you waxed, had a chemical peel, facial treatment, or used retinol in the last 7 days? *

Yes No

Please list your current vitamins and medications *

Have you ever had any reaction to Eyelash Lifts or Lash/Brow Tints in the past? *

Yes No

I agree not to use water-proof mascara and to only use recommended products after your treatment.

Cancellation, No-Show and Refund Policy

Cancellations and requests to rescheduled are only accepted via phone call. Emails, text messages, and social media messaging are not accepted as a way to contact other than inquiries. We ask that you consider the amount of time our staff blocks off for your appointments. When you forget to cancel your appointment in a timely manner, we miss the opportunity to fill that spot with guests on our Wait List.

Cancellations between 3-24 hours of your appointment will either forfeit the non-refundable, non-transferable retainer placed for new clients or 50% of the appointment will be charged to your account on file.

Cancellations less than 3-hours or failing to show up for an appointment is considered a "No-Show" and 100% of the appointment will be charged to your account on file. Please note, showing up more than 15-minutes late for your scheduled appointment is considered a "No-Show."

A credit card MUST be kept on file for all future appointments. If a card was not able to be charged due to a missed appointment, that missed appointment must be paid prior to scheduling your next appointment.

Refunds are not given once any service is rendered, including allergic reactions. We strive to offer the best quality service. If you are unsatisfied with your service, we ask you contact management within 3-days of service to help decide what the best option is.

I acknowledge it is my responsibility to notify Scarlett's Beauty Bar & Spa of any changes to my credit card information and will keep a current credit card on file at all times.

Signature *

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