EYELASH EXTENSION CONSENT FORM

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Please check the boxes before the statements below:
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I agree to have lash extensions on my natural eyelashes and/or removed or retouched. By signing this agreement, I consent to the placement or removal of eyelash extensions by the certified eyelash extension professional.

I understand there are risks associated with having artificial eyelashes and eyelash extensions applied to, or removed from my natural eyelashes. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blindness can occur. I agree that if I experience any of these medical conditions with my lashes I will contact the certified eyelash extension professional and have the eyelashes removed immediately and consult a physician at my own expense.

I understand that even though the certified eyelash extension professional applies or removes the eyelash extensions using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care and subsequent removal of the eyelash extensions.

I understand and agree to the care 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, damage the extensions and/or decrease the time the lashes will last.

I understand and consent to having my eyes closed and covered for the duration of the 60-120 minute procedure. I understand that if I have lower eyelash extensions applied that I will have my eyes open and will have instruments, tapes, cleaners, eye gel pads, adhesives, and removers used that may irritate my open eyes, cause them to water and blink in excess, preventing application and/or requiring removal and a physician’s follow-up care and subsequent removal of the eyelash extensions

Required

I am informing the certified eyelash extension professional of the following conditions by marking with a check:
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Current use of contact lenses which I agree to remove during eyelash extension application

Current use of eyedrops of any kind, prescription or over-the-counter

Current use of anything such as oil-containing sunscreen or moisturizers around the eyes

Current allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives, and removers that could cause my eyes to water and blink in excess

History of claustrophobia.

History of recurrent eye or tear duct infections

History of dry eyes or Sjorgen’s Syndrome

Recent history of Chemotherapy

Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions.

Required

I agree to the following pre-appointment instructions. To maximize your lash time and retention, we recommend:
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That you come to your lash appointment without mascara and avoid wearing waterproof mascara 3 days before your appointment.

You do not consume liquids immediately before your appointment or caffeine the day of.

Avoid spray tanning before your appointment (after ok)

You bring your contact case and solution and arrive a little bit early so that you are prepared to remove your contacts before your lash extension application appointment.

Avoid oily facial serums & lotions that can affect the lash adhesive retention within 24 hours.

Please avoid tanning bed & direct water/steam exposure for 3 days AFTER your lash extension appointment, the slower your lash adhesive cures the less brittle the bond will be and this will result in better lash retention. This is crucial to achieve the best results!

Lashfill appointments will be required approximately 3 weeks after your fresh full set of lash extensions and should be scheduled at the time of initial appointment to ensure studio availability in a timely manner, if you do not get into the studio before 4 weeks you will be required to book in for another full set so please book your lash fills well in advance.

Required

I agree to the following eyelash extension post-op and maintenance instructions:
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I agree to the following eyelash extension post-op and maintenance instructions:

No prescription or over-the-counter eye drops

No water can come in contact with the eye area for 24 hours of the application

No oil based products around the eye area

No tinting or perming of eyelash extensions

No continuous pulling or rubbing of the synthetic lashes

Required

This agreement will remain in effect for this procedure and all future procedures 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. I am over 18 years of age and consent to the agreement and to treatment.

I release my technician or salon from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There is no guarantee for the bonding time of the eyelash extensions. This salon is not responsible for any technician errors. I understand the after care instructions and will do my part to maintain my eyelash extensions. I understand that there are many factors that may affect the life of the eyelash extensions such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures.

Required

Full Name *

Date of Birth *

Instagram/Facebook Account *

I acknowledge that Elevate Lash Lounge is strictly open by appointment only.

I agree to come ON TIME but NOT EARLY to my appointment to give time for the staff to properly prepare for my appointment & out of consideration to previously booked clients.

Required

I hereby grant permission to Elevate Lash Lounge Inc to take photos or videos during service for promotional, educational or marketing purposes.

By submitting this consent form, I verify that I have read and understand the above statements and agree to them.

I acknowledge that this consent form is legally binding & submitting this indicates that I agree & signed to it.

Required

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