Full Name *

Full Name

Date *

Phone *

Referred By *

Do you have social media? *

e.g., Yes or No

Instagram profile link

Facebook Page Link

TikTok profile link

Have you had eyelash extensions before? *

e.g., Yes or No

Have you ever experienced allergic reaction to eyelash extensions? *

e.g., Yes or No

Do you have sensitive eyes? *

e.g., Yes or No

Allergic reactions to eyelash extensions are caused by an allergy to the cyanoacrylate base (bonding agent) that is basically in every eyelash extension adhesive. If you develop an allergy to the adhesive you may experience swelling, itchy eyes, and/or redness. Allergic reactions to the lash adhesive are rare. I ask that you do not get eyelash extensions if you have experienced allergies to the lash adhesive ever in the past or if you have very sensitive eyes.

I certify that I have read all the information above.

I fully understand that I am fully responsible for the maintenance of my eyelash extensions.

I understand that it is my responsibility to keep my eyes closed and stay still during the entire application process.

I understand that I am required to follow the eyelash extension aftercare instructions in order to maintain the health of my natural lashes and the extensions.

I understand that the fumes from the adhesive may cause my eyes to water during the application process.

I understand that some of the risks involved with this procedure may be, but are not limited to eye redness, swelling, and/or irritation.

I understand and acknowledge that this consent & release discharges me, (your name here), from any liability or claim that I may have with respect to any bodily injury, personal injury, property damage or any other claim that may result from the services provided.

Disclaimer: Your lash technician is only certified not licensed.

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