Consultation and Consent Form

Clients Name_____________________________________________________________

Phone number______________________________DOB___________________________

Address _________________________________________________________________

How did you find us________________________________________________________

Consultation Information Statements

Please read the following information.

Lash extensions are made of a synthetic material naturally curved to imitate your natural
lashes.
There purpose is to create the look of thicker, fuller and longer eyelashes.
The procedure is painless.
Maintenance procedures may be required.
For two hours after Rinadi Lashes treatment do not allow water to contact lashes.
For two days after Lash treatment do not steam face, use steam bath or solar, swim or
wash face with hot water.
Com gently your lashes and wash them with water and baby shampoo.
Do not perm or curl Lash Extensions.
Eyelash tinting must be done prior with 2 days to your lash procedure.
Only use water based mascara on the tips of your lashes.
Do not use waterproof mascara or mascara remover on lashes.
Do not rub eyes when washing face.
Always pat dry lashes after cleansing.
Do not use the sauna or a face steamer everyday.
Do not use any makeup remover on or near the lashes
Do not sleep on your face

Consent for procedure

I understand that a maintenance procedure is required to keep the lashes looking thick and full
and I am
aware that I will be charged an additional fee for any further work.
I have read and understood the aftercare form and realise I am responsible for the general care of
my lash
extensions.
PATCH TEST PROCEDURE I am aware that it is an insurance requirement for a patch test to
be completed 48 hours prior to my full treatment.

Clients name ...................................................... Patch test completed on ..//...

Signature.................................................................. Date ......................................................
 Medical Health Form
Clients name________________________________________________

Please mention any illnesses/surgical or cosmetic procedures that you underwent in the last 6
months:

(Please circle)

Allergies: (latex, medical tape, gel eye patches, petroleum jelly) Y N

Ashma or any respiratory(breathing) problems Y N

Cataract Y N

Conjunctivitis Y N

Diabetic Retinopathy Y N

Dry Eye Syndrome Y N

Glaucoma Y N

Sensitivies(itchy eyes, seasonal hay fever) Y N

Pregnancy Y N

Able to lie on your back for 2-3 hours Y N

Do you wera contact lenses? Y N

Will you remove them? Y N

Lifestyle

Hot Yoga Y N, gym Y N, swimming pool Y N, eye makeup Y N, Face treatments Y N, work
in high humidity environment Y N, eyelid treatments(serum, creams) Y N, skin type normal-
dry -oily mixed

I have read and understood the above information

Client name .................................................... Signature ................................ Date ........................
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