Lash Lift and Tint Consent Form

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Email *

I agree to have a lash lift & tint on my natural eyelashes. By signing this agreement, I consent to the use of a perming solution & dye on my natural lashes by the certified eyelash professional.

Required

Please check the boxes before each statement: *

I understand there are risks associated with having my natural lashes lifted & tinted. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, an eye infection or blindness can occur.

I agree that if I experience any of these medical conditions with my lashes I will contact Elevate Lash Lounge immediately with details and consult a physician at my own expense.

I understand that even though the certified eyelash professional applies lash lift & tint 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 maintenance.

I understand and agree to the care instructions provided by the certified eyelash professional for the use and care of my lash lift & tint.

I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to fall out, damage the natural lashes and/or decrease the time the lift & tint will last.

I understand and consent to have my eyes closed and covered for the duration of the 60-90 minute procedure.

Required

I am informing the certified eyelash 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 lash lift & tint procedure

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.

None of the above

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.

Please avoid tanning bed & direct water/steam exposure for 24 hours AFTER your lash lift appointment.

Required

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

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.

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 how long a lash lift & tint lasts. This salon is not responsible for any technician errors. I understand the aftercare instructions and will do my part to maintain my lash lift & tint. I understand that there are many factors that may affect the life of the lash lift & tint such as water and moisture contact, use of mascara, 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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