Lash and Brow Chemical Service Consent For Lifts, Tints & Lamination Services

This Form is for Lash Lifts, Lash Tints, Brow Tints and Brow Lamination procedures. This form is not for Waxing Services -use General intake & Waxing Form for brow waxing services
  • MM slash DD slash YYYY
  • If you are a minor, in addition to this form, you must fill out a General Intake & Waxing consent form, including the parental consent portion. This form is located on the website under the FORMS tab.
  • MM slash DD slash YYYY
    If you are receiving a lash treatment (lift or tint) you will need to arrive with contacts removed. It is suggested to wear glasses after treatment if possible.
  • Please list the procedure you had and when.
  • lash lift, lash tint, hair perm or hair color
  • Such as eyelash glue or nail glue.
  • If there are none please list N/A
  • PRE TREATMENT INSTRUCTIONS: Please arrive with no make up, or products on the area to be treated, this includes areas above or below the eye area. Please make sure that lashes or brows have been thoroughly cleaned removing any debris, make up or product. This will ensure good product penetration. Any oil based cleansing products should be avoided as they leave a residue. For lash services, contacts must be removed prior to appointment. It is suggested that you wear glasses instead of contacts to and from your appointment. If you are sensitive to caffeine please avoid before your appointment. Please note if your eyes tear or water excessively it may prevent your service provider from being able to apply products.
  • POST Treatment Instructions: Areas treated should be kept dry for 24 hours after treatment.
  • I understand that if I have any concerns, I will address these with my technician/esthetician. I give permission to my technician/esthetician to perform treatments/procedures and will hold him/her/them and his/her/their staff harmless and nameless from any liability that may result from this treatment/procedure. I understand 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 have been provided sufficient opportunity for discussion and to have any questions answered. I understand the procedure and accept the risks. I do not hold the technician/esthetician, responsible for any of my conditions that were present but not disclosed at the time of this procedure that may be affected by the treatment performed today I agree to update my service provider of any changes to this form. I understand photos may be taken for documentation purposes and may be used in promotional materials and social media posts.