ALL SERVICES:

I certify that the preceding medical, personal, and skin history statements are true and correct. I am aware that it is my responsibility to inform my esthetician of my current medical and health history and to update any current conditions. A current medical history is essential for the caregiver to execute the appropriate treatment procedures. (All information is strictly confidential)

LASH LIFT SERVICES:

I agree to the following Lash Lift care and maintenance instructions:

No water can come in contact with the eye area for 24 hours after the applications.

This agreement will remain in effect for this procedure and all future procedures conducted by my esthetician.

I have read the above information. If I have any concerns, I will address these with my esthetician. I give permission to my esthetician to perform the Lash Lift procedure we have discussed and will hold him/her and his/her staff harmless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the esthetician responsible for any of my conditions that were present, but not disclosed at the time of this procedure that may be affected by the treatment performed today.

Please submit your acknowledgement and understanding of the above by typing your full name below.