Lash Lift Consent Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Although every precaution will be made to ensure your safety and well-being before, during, and after your lash lift application, please be aware of the possible risks below.

Email *

I understand that having my eyelashes lifted or permed may have some risk of irritation to the orbital eye area, including, but not limited to the eye itself. If solution enters the eye, it can result in a stinging or burning sensation, blurred vision, and in severe cases blindness if the eye is not immediately flushed. *

Yes

Required

I understand that if the lash lifting agent gets in my eye, then my eye will be flushed with sterile eyewash and medical attention may be required. *

yes

Required

I understand that natural eyelashes have a growth cycle and my natural eyelashes grow and shed. Receiving consistent lash lifts is required to keep the lifted appearance. I understand that maintenance is recommended every 6-8 weeks. If yes, please describe: *

yes

Required

I understand that, while every attempt will be made to provide me with my chosen degree of lash curl, there are many factors on how hair absorbs the solution and my results may not be the curvature I initially requested. *

yes

Required

Agreement:

I have read the above information. If I have any concerns, I will address these with my stylist immediately. I give permission to my stylist to perform the tinting procedure we have discussed and will hold A Little Lash shop and any of its owners/employees harmless from any liability that may result from this treatment. I have accurately answered the questions on the Client Intake Form, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my stylist will take every precaution to minimize or eliminate negative reactions. If I have additional questions or concerns regarding my treatment, I will consult my stylist 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 had sufficient opportunity for discussion of the process and all my questions are answered. I understand the service and accept the risks. I do not hold the stylist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I acknowledge this agreement for all lash lift services received within a year from signing date.

Client Name *

Client Email *

Signature *

Date *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of You're A Big Deal. Report Abuse

Forms