Lash Lift/Tint Client Consultation Form

Lash Lift/Tint Consultation Form

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

Phone

Date of Birth

Sex

Emergency Contact Information

Name

First

Last

Phone

Relation to Client

Medical Details

Have you ever had an eyelash tint or lift before?

Do you currently have irritated, itchy, or watery eyes?

Are you allergic to perms, hair colour, or tape?

Do you wear contact lenses?

If yes, do you agree to remove them for the procedure?

Are you currently being treated for an eye illness, eye injury, or skin condition?

If yes, please describe

Please Detail Any Allergies

Please Detail All Medication You're Currently Taking

I give permission to the lash technician to perform the following procedures:

Lash Lift/Perm
Lash Tint

The eyelash lift and tint procedures are performed with the proper technique, products, and instruments, and with your safety in mind. however, there still are some risks associated with the procedure(s). This consent form is intended to inform you of the risks of the procedure(s) and to obtain your informed consent for the procedure(s).

I understand that as part of the procedure(s), eye/skin irritation, redness, swelling, pain and discomfort can occur. And although rare, eye infection or allergic reaction can occur. I agree to seek medical attention at my own expense if I experience any of these conditions.
I agree that if the tint or perming agents comes into contact with my eye, my eye will be flushed with water and I will seek medical attention at my own expense immediately.
I understand that the procedure(s) can take up to 90 minutes. I agree to lie down with my eyes closed for the duration of the procedure(s).
I agree to the aftercare procedures recommended by the technician. I understand not adhering to the aftercare procedures can impact the results of the lash lift/tint.
I understand that results of the procedure may vary based on my natural lashes and my final result may not be what I initially envisioned.
I give the technician permission to photograph my lashes for their own marketing and promotional purposes.
I understand that the lash lift/tint procedure is semi-permanent, and will require a retouch and upkeep.
I completed the above form to the best of my knowledge and consent to the lash lift and/or tint procedure. I have had the opportunity to ask any questions and have received satisfactory answers. I understand the risks and potential side effects associated with the procedure(s). I understand that the results of the procedures are not guaranteed and may vary from person to person. I am over the age of 18 and consent to the procedure(s). I will not hold the technician, salon, or employees liable for any issues not disclosed at the time of my service or any adverse effects from the procedure(s). This agreement remains in effect for this procedure and any follow-up appointments.

Customer Photo

Click or drag a file to this area to upload.

Date

Signature