Name *

First Name

Last Name

Phone *

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Please inform your Esthetician of the following conditions by marking the box(es) below.

I have had eyelash extensions before.

I'm allergic to adhesives, and removers that could cause irritation of any kind. (glue, tape, band-aids)

I have latex allergies

I have seasonal allergies

I currently use contact lenses.

I suffer from claustrophobia

I have a history of recurrent eye or tear duct infections

I have a history of dry eyes or sensitive eyes

I have a recent history of Chemotherapy

Other medical conditions or medications that you take which would prohibit or compromise placement & retention of eyelash extensions

I have read and understand the Aftercare + Precare/FAQ's and Policies section for lash extensions on the website. I 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 my Esthetician. 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 that I will contact my Esthetician that performed this procedure and it may be beneficial to have the eyelashes removed. I understand and agree to the before care, expectations during my appointment, and aftercare instructions provided by my Esthetician 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 120 minute procedure. Times may vary depending on the type and number of eyelashes applied. I acknowledge that I should not pluck, pull or cut my lashes after they have been applied or rub my eyes heavily. I agree to only use recommended products on my professional eyelash extensions. If I do not, my lash retention may be affected and I will have to come in for a fill right away or another full set. I understand that there are many variables including technician expertise, natural lash growth cycle, use of cosmetics and skin care products, and the overall maintenance given that will influence how long my eyelash extensions remain in place. I understand that there is a potential possibility of allergic reaction -- as with all cosmetic products. I understand that using mascara on my lash extensions will shorten the length of time my extensions remain in place. I have also been advised not to use any type of mascara on my eyelash extensions. I understand if I wait after 4 weeks, it will be a full set charge. I understand that if I am late to my appointment or leave before my appointment time is over then I can not come back and receive any touch ups or services free of charge. I understand to not get my lashes wet or apply eye make-up for at least 24 hours after every lash appointment. I understand that touch-up/fill appointments are necessary as soon as two to three weeks at the most after the application and when my lashes are at least 50% full. If lashes are less than 50% full, there will be an extra charge and you may need to be rescheduled to allow for more lashing time. *

I agree and clearly understand all the terms and conditions stated above.