LASH EXTENSION

CONSENT FORM

APPOINTMENT DATE APPOINTMENT TIME

FIRST NAME LAST NAME

ADDRESS PHONE NUMBER

EMAIL ADDRESS INSTAGRAM @

I give permission to take "before and after" pictures for adverting and marketing purpose.
I understand that these pictures can be posted on social media.

I understand there are risks associated with lash extensions.

I agree to the after - care instructions given by the technician and realize that not following
these instructions may result in damage to my natural lashes.

First time lash lifting. Frequent eye irritation, itching or watering eyes.

I wear contacts. Resent permanent eyeliner.

Eye surgery within the last 6 months. Current use of eye medication or antibiotics.

I'm pregnant. Blepharoplasty.

Other medical information:

By signing this form, I approve that I understand all the information listed. I consent to this agreement
and the lash extension procedure.

CLIENT SIGNATURE: DATE:

TECH SIGNATURE: DATE: