Eyelash And/or Eyebrow Extensions Agreement And Consent Form printable pdf download

Eyelash And/or Eyebrow Extensions Agreement And Consent Form

Waxpress and Facial Studio

Eyelash and/or Eyebrow Extensions Agreement and Consent Form

Full Name: ____________________________________________

Telephone: (Cell)_________________________________________

Email: _______________________________________________

Referred by: ___________________________________________

Initial

_____ I understand that this procedure requires single synthetic lash hair to be glued to my own natural

eyelashes/eyebrows.

_____ I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until

my eyelash technician addresses me to open my eyes.

_____ I understand that some risks of this procedure may be but not limited to eye redness and irritation. The

fumes from the adhesive may cause my eyes to tear up if I open my eyes.

_____ I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.

_____ I understand that I am required to follow the eyelash/eyebrow extension care sheet (attached hereto) in

order to maintain the life of these extensions.

_____ I agree that by reading and signing this consent form, I release Waxpress from any claims or damages of any

nature.

_____ I agree that I read and fully understand this entire consent form.

_____ I am of sound mind and fully capable of executing this waiver for myself.

_____ I give Waxpress permission to show my before and after photos of eyelashes to other potential clients

Yes _____ or No _____

_____ I have read and completed the Eyelash/Eyebrow Extensions Intake & Consent form in its entirety, and have

answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects

that may be caused by the application and/or removal of Eyelash/Eyebrow Extensions.

I confirm and agree that I wish to engage the services of Waxpress to apply eyelash/eyebrow extensions.

Print Your Name: __________________________________________________________

Signature ____________________________________ Date ________________________

Eyelash And/or Eyebrow Extensions Agreement And Consent Form