Eyelash Extension Intake & Consent Form
Sign in to Google to save your progress. Learn more
Email *
Name *
Full Address (Street, City, State, Zip) *
Cell Phone # *
I have agreed to allow Tru Salon to apply eyelash extensions or remove eyelash extensions. Before my qualified professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.

Waiver of Liability

I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that not withstanding the utmost of care in the application or removal of these products, there still exists risks associated with the procedure and product itself. These include, without limitation, eye irritation, eye pain, discomfort, and, in very rare cases, blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial lash to my existing eyelashes. Even though the professional may apply or remove my lashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying lashes to my eyelashes, and I will not attribute any liability to the professional as a result of this procedure or the use and care of these lashes. I also agree to defend, identify and hold harmless Professional from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fees which might be asserted against them as a result of my having this procedure performed or my purchase of their respective officers, directors, agents, employees, successors and assigns.

Care and Maintenance

I agree to follow the care and maintenance instructions provided by Tru Salon for the use and care of my lashes and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my lashes or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of my lashes. I will avoid getting my lashes wet within the first 24 hours after my application. For the first two days after application I understand it is best to avoid swimming, saunas, or steam rooms. If I experience any itching or irritation, I agree to contact Tru Salon immediately to have lash extensions removed. I agree to avoid waterproof mascara and to not use an eyelash curler, perm, or tint on my lashes. I agree to not pick, pull or rub my lashes. I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.

I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelashes) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucous membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2 hours or longer with my eyes shut. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to Tru Salon’s instructions or these warnings.

I acknowledge that maintenance is an option that I choose to proceed with or forgo. When scheduling lash extension touch-ups, I understand this appointment is based strictly on length of time. The professional will attach lash extensions for the full duration of time the appointment allows. This does not guarantee a full set if time does not allow. When booking my touch-up appointments, I will be mindful of how long it has been since my last lash extension visit and plan accordingly. If the time in between touch-ups exceeds 6 weeks, I understand it is required I receive a full set and will be charged accordingly.I understand coming to my lash appointment, without having priorly cleaned my lashes, will result in time being taken from the actual lash fill process so the professional can clean my lashes.

Permission to use pictures: I hereby grant Tru Salon the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by Professional. I further expressly assign any copyright in these photographs to Tru Salon. I also grant my consent for Tru Salon to use my image and likeness as contained in these photographs for any advertising or other purposes, along with any comments I may provide. Please use these images with the following... *
I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am over 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement, and his or her relationship to me is as follows.
Relationship to the minor
By his or her signature below, he or she ratifies and consents to this procedure under these terms.
I acknowledge that by electronically signing this form, I hereby agree to the terms and conditions in this document. *
Electronic Signature (First & Last Name) *
Parent or Guardian Electronic Signature
Date of Signature *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Tru Salon. Report Abuse