Lashes – Makes Consense

Before my qualified professional eyelash technician can perform this procedure, I understand I must complete and sign this consent form.

Yes
No

Date*

Technician*

Treatment*

Patch test date

I agree to a patch test of the products used during treatment, I will notify staff immediately if I have any adverse reaction that may cause the treatment to cancelled or abandoned

Clients Name*

First Last

Address*

Street Address Address Line 2 City County Postcode Country

Contact Number

Date of birth*

Email*

Medical information (please tick if yes)

If yes to any of above, please give details.

I have agreed to have eyelash extensions applied and/or removed from my natural lashes.*

Yes

I understand there are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes*

Yes

I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight, thereby preserving the health, growth and natural look of the clients natural eyelashes.*

Yes

I understand as part of the procedure eye irritation, eye pain, eye itching, discomfort and in very rare cases an eye infection may occur, I understand and agree that if I experience any of these issues with my lashes or eyes I will contact my technician and have the lashes removed immediately and consult a physician at my own expense*

Yes

I understand that even though the technician may apply and remove the eyelashes properly, that adhesive materials may become dislodged during or after the procedure, which may irritate the eyes or require further follow up care.*

Yes

I understand and agree to follow the aftercare instructions provided by my technician. Failure to follow the aftercare instructions can lead to poor results.*

Yes

I understand that in order to have my eyelash extensions applied I will need to be laying in a reclined position and keep my eyes closed for a duration of 60-100 minutes during the treatment. Any medical reason that prevents this will result in refusal of treatment.*

Yes

This agreement will remain in effect for the procedure and all future treatments, I agree to sign a subsequent visit form on each visit to declare any changes in circumstances.*

Yes

TREATMENT LOG

Treatment

Treatment log

Before image

After image

TO BE COMPLETED AFTER TREATMENT

I am happy with the way my technician has applied my eyelash extensions

Date

I confirm I have received the aftercare instructions

Date

TREATMENT LOG

TO BE COMPLETED AFTER TREATMENT

Login