Consent Form – Eyelash Extensions I agree to have tab/mink eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and 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 itching, and in rare cases, eye infection 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, 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 tab/mink eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the tab/mink 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 30-45-minute procedure. I am informing the certified eyelash extension professional of the following conditions by marking with a check: check all that applyCurrent use of anything such as oil-containing sunscreen or moisturizers around the eyesCurrent allergies or sensitivities to instruments, fumes, tapes, cleaners, adhesives, and removers that could cause my eyes to water and blink in excessHistory of claustrophobiaHistory of recurrent eye or tear duct infectionsHistory of dry eyes or Sjorgen’s SyndromeRecent history of Chemotherapy.Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions I agree to the following eyelash extension maintenance instructions: • No waterproof mascara • No prescription or over-the-counter eye drops • No oil based products around the eye area • No water can come in contact with the eye area for 24 hours of the application • No tinting or perming of eyelash extensions • No continuous pulling or rubbing of the synthetic lashes 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. Clients have up to 24 hours to fix or remove their extensions at no additional cost, after the 24-hour period, this salon is not responsible for adding or removing any lashes. There will be a charge. Client's Signature Phone Date Any Allergies? Submit
