Eyelash Extensions Consent

Full name

First Name

Last Name

Date of Birth (we have birthday coupons)

Age

Cell phone number

Email

Are you under the influence of alcohol or drugs?

Yes No Prefer not to say

Is this your first time having eyelash extensions?

Yes No I had them a long time ago

What are you having lash extensions applied for?

Do you wear contacts?

Yes No Sometimes

Do you have any makeup around your eyes today?

Yes No I just removed it

Do you often rub, pull, or pick your lashes for any reason?

Yes No Occasionally

Do you have, or are you being treated for, any eye illness or injury?

Yes No In the past

Please list any eye drops or eye medication you are currently using

Are you able to lie on your back for 2 hours to have your lashes applied?

Yes No Yes, with breaks

Will you be able to keep your eyes completely closed for up to 2 hours?

Yes No Not sure

Are you pregnant?

Yes No Prefer not to say

What other products do you currently use around your eyes? (eye creams, ointments, lash growth serums, etc.)

Please note: oil-based products around the eyes should be discontinued for 48 hours after your lash service, and it is best to avoid them for as long as you wear extensions; oils, waterproof mascaras, and liners loosen the adhesive and shorten wear time.

For longevity we recommend skipping mascara (your lashes will look so glamorous you won't need it); if you must use it, make sure it is oil-free and remove it daily with an oil-free cleanser such as our eye wash or drugstore options.

Do you use lash growth serums, over-the-counter or prescription? It is best to stop them 2 weeks before your service and while wearing extensions, since some contain oils or steroids that shorten their lifespan.

Yes, currently I stopped recently I have never used them

How do you usually sleep? You will lose more extensions on the side you sleep on; sleeping on your stomach affects them the most and should be avoided for the first 2 days so the adhesive sets properly.

On my back On my side On my stomach It varies

Are you allergic to adhesives (glues, tapes, band-aids, etc.)? This service uses tapes, glues, and gel pads that may cause a reaction; we use a medical-grade, formaldehyde-free adhesive, but allergies can still occur.

Yes No Not sure

Have you had chemotherapy treatments in the last 6 months? The medication may cause a reaction to the materials, and if your lashes are just growing back it is best to wait until they are strong enough.

Yes No More than 6 months ago

Have you had Lasik surgery in the past 4 months? Eyes may be sensitive to lash extensions and the prepping products (gel pads, glues, etc.).

Yes No More than 4 months ago

Are you currently taking thyroid medications? Extensions may not last as long due to the medication or the thyroid condition itself.

Yes No In the past

Blepharoplasty or another eye surgery or condition in the last 6 months? You may be sensitive to the extensions and products; consult your doctor first about whether this service is safe for you.

Yes No More than 6 months ago

Do you wear contact lenses? They must be removed prior to the procedure: products may get underneath the lens and cause an abrasion or scratching.

Yes, I will remove them I don't wear them Sometimes

Do you have extremely oily skin and/or hair? Natural oils break down the adhesive and extensions may fall out sooner; it does not prevent the service, it may just shorten wear time.

Yes No Not sure

Read and accept the following studio policies before signing.

I understand that extensions require ongoing maintenance (similar to a nail service); refills are recommended roughly every 2.5 to 4 weeks, and going beyond that window may require a full set or a higher relash price.

I acknowledge and understand that the studio does not issue refunds; the lash technician will do their best to satisfy the client.

I will seek medical care (at my own expense) and contact my technician immediately if any allergic or adverse reaction occurs; all my questions were answered and I understand the procedure and its risks.

I agree and understand that the lash technician has no way of knowing whether the client is allergic to any of the products or materials used in the procedure.

I grant permission to use my before and after photos for marketing or as examples of my technician's work.

Yes, I authorize it No Only without showing my face

I release my certified lash technician and the studio from any and all liability associated with this procedure; the service will be performed with the utmost attention to safety, sanitation, and proper application, using tools and products the technician is trained and certified to use. This service has many variables (lifestyle, moisture, weather, extreme temperatures, natural lash shedding, and other factors), and the technician, together with this consent form and consultation, will decide to the best of their ability whether I am a good candidate for the service.

Final confirmation

I have read and agree to everything above The information provided is accurate I am over 18 years old

Sign date

Client signature

Sign here

Eyelash Extensions Consent

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