Femme Jolie E.D.S. - Eyelash Extension Consent Form

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If for any reason I am unhappy with the treatment services then I must inform the eyelash extension professional ASAP and no later 3 days after treatment. I understand that NO REFUNDS will be issued on any treatment. I will inform my eyelash extension professional if my medical history changes.

I consent to having my photo taken for advertising, education and promotional use without compensation.

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 18 years of age or older and consent to the agreement and to the eyelash application procedure.

Email *

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 the certified eyelash extension professional at Femme Jolie Eye Design Studio. (Please type your full name below.) *

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

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 my cause the eyelash extensions to fall out and decrease the time the lashes will last. (Please Initial Below.) *

I understand and consent to having my eyes closed and covered for the duration of the 60-180 minute procedure. Times may depending on the type and number of lashes applied. (Please Initial Below.) *

I have informed the eyelash extension professional of the following conditions by marking all that apply: *

Current use of contact lenses (which I may be asked to remove before or during the procedure.)

Current use of anything containing oil such as 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.

History of Sjorgen's Syndrome.

Recent history of Chemotherapy.

Other:

Required

Please list any other medical conditions which would prohibit or compromise placement and retention of eyelash extensions. Type, "None" if not applicable. *

By checking each box I acknowledge that I have read and understand the following eyelash extension follow-up and maintenance instructions: *

NO water contact with the eye are for 24-48 hours after the application.

NO oil based products around the eye area.

NO Mascara of any kind on the eyelash extensions/other false lash products. Use on lower lashes is permitted.

NO tinting/perming/lash lift procedure on the eyelash/other false lash applications.

NO pulling or rubbing of the eyelash extensions/other false lash applications.

NO direct exposure of excessive heat (sauna, oven, blow dryers) to your eyelash extensions.

Should any kind of eye drops be necessary, extra care should be taken to prevent moisture from coming into contact with the eyelash extensions.

My 1st fill needs to be scheduled within 2 weeks of application to determine my lash growth cycle and establish a refill schedule between 2-4 weeks.

Required

Please sign and date below. *

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