Eyelash Extension Consent Form

Informs each client about the extension procedure, the materials involved, and possible reactions before you begin. It captures their history, the patch test option, and both client and technician signatures in one document.

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Name

Nombre

Apellido

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

How did you hear about us?

Instagram Facebook Google search Friend referral Walked by the salon Other

Please check any of the following that applies to you

Recent eye infection Sensitive eyes Alopecia Recent eye surgery Adhesive allergies None

Have you ever had eyelash extensions before?

Yes No Not sure

If not, would you like a patch test, which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen)

Yes, please No, thanks I need more information

If yes, where were they applied and what brand was used?

Please accept the terms and conditions

I accept the service terms I understand the risks I accept the aftercare instructions

Date

Client Signature

Sign here

Technician Name

Nombre

Apellido

Technician Signature

Sign here

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