Eyelash Extensions Consent Form

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

I agree to allow pictures to be taken and shared of me.

I understand that in 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 and that I will contact the certified eyelash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed.

I understand that if I choose to reschedule or cancel my appointment I must give a 48hr notice or I will be charged the full price of the service not including any discounts or specials.

I understand that there is no refunds of any kind for any reason.

I understand that my lash artist is not responsible for any after care of the lashes and is not responsible for any side effects with eyelash extensions.

I understand that I will need to maintain my extensions by getting them filled every two to three weeks.

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 having 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 anything such as oil-containing sunscreen or moisturizers around the eyes
Current use of eye drops of any kind, prescription or over-the-counter
Current allergies or sensitivities
History of recurrent eye or tear duct infections
Recent history of Chemotherapy
Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions

I agree to the following eyelash extension follow-up and maintenance instructions:

No waterproof mascara - No oil based products around the eye area - No water can come in contact with the eye area for 24 hours after the application - No tinting or perming of eyelash extensions - No pulling or rubbing of 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. I agree to pay the amount due in full at the time of my appointment.

Client Signature

Parent or Guardian Consent (Required for Minors):

Date

Minor?

402 669 7094

By Appointment Only

4935 S 136th St, Omaha, NE, 68137

Eyelash Extensions Consent Form

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