EYELASH EXTENSION CONSENT FORM

I agree to have eyelash extensions applied to my natural eyelashes and/or removedand retouched. By signing this agreement,
I consent to the placement and/or removal of the eyelash extensions by a certified eyelash extension professional.

I understand that on rare occasions, there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases, as part of the procedure, eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes, I will contact the certified eyelash extension professional that performed this procedure, and it may be beneficial to have the eyelashes removed.

I understand and agree to the after-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 and/or decrease the time the lashes will last.

I understand and consent to have my eyes closed and covered for the duration of approximately 60-120 minute procedure. Times may vary depending on the type and number of eyelashes applied.

I am informing the certified eyelash extension professional of the following conditions by marking with a check:
Current use of contact lenses which I may be asked to remove during the procedureCurrent use of anything such as oil-containing sunscreen or moisturizer around the eyesCurrent use of eye drops of any kind, prescription or over-the-counterCurrent allergies or sensitivitiesHistory of recurrent eye or tear duct infectionsHistory of dry eyes or Sjorgen’s SyndromeRecent history of ChemotherapyOther medical conditions would prohibit or compromise the placement and retention of eyelash extensions

I agree to the following eyelash extension follow-up and maintenance instructions:
No waterproof mascaraNo oil-based products around the eye areaNo water can come in contact with the eye area for 24 hours after the applicationNo tinting or perming of eyelash extensionsNo pulling or rubbing of the eyelash extensionsShould any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the eyelash extensions.

This agreement will remain in effect for this procedure and all future follow-ups 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 the eyelash extension application procedure.