Lash Fox | Lash Fox Beauty Consent Form – Lash Extension Model Promotion

Name *

First

Last

Email *

*Email may be used to confirm appointments, send notifications or promotions

Phone *

Emergency Contact *

First

Last

Emergency Contact Phone *

You must be over 18 to consent to services. You must be over 16 to receive services. Under 18 requires parental signature *

I am over 18
I am over 16

Parent Signature Required if client is under 18 (but must be over 16)

Have you had lash extensions in the past?

Yes
No

Please explain if you had any problems, reactions or sensitivities to your lash extensions.

How long ago was your last lash extension service?

PLEASE READ AND UNDERSTAND THE FOLLOWING:

Each box check provides electronic confirmation & consent

I agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of eyelash extensions by the certified eyelash extension professional and release Lash Fox Beauty from any damages. *

I agree
I would like to discuss this further

I understand there are risks associated with having artificial eyelashes and eyelash extensions applied to, or removed from, my natural eyelashes. Despite application of the most advanced and top ingredients, an allergic reaction is possible. I understand I may request an allergy test, but it must be done a minimum of 48 hours prior to application. *

I agree
I would like to discuss this further

Some irritation, itching or burning may occur on the skin if the adhesive comes into contact with it. I agree that if I experience any of these conditions with my lashes I will contact the certified lash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed. *

I understand
I would like to discuss this further

If any products come into contact with my eye, my eye will be flushed and I will be assisted in seeking medical attention immediately. *

I understand
I would like to discuss this further

This is a semi-permanent procedure, as my natural lashes will continue to grow and fall out naturally, making touch-up or 'fill' appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks. A full set is required for any appointment booked further than 4 weeks apart. *

I understand
I would like to discuss this further

I understand and consent to having my eyes closed for the duration of an approximately 60-120 minute procedure and that it is my responsibility to keep them closed and remain still during this time. Procedure times vary. *

I understand
I would like to discuss this further

It is my responsibility to prepare my eye area prior to arrival. Eyelashes and eye area should be clean, dry, and free of mascara, makeup, and oil residue. If I attend my appointment without proper preparation, Lash Fox Beauty cannot guarantee lasting or satisfactory results and may charge me a cleaning fee prior to application. *For best results please let us know if you have any mascara or residue on your lashes. *

I understand
I would like to discuss this further

I understand and agree to the following after-care instructions for the use and care of my eyelash extensions. I realize and accept the consequences of failing to adhere to these instructions may cause the eyelash extensions to fall out and/or decrease the time the lashes will last. *

Lash extensions must be kept clean. Cleansing with a lash approved cleanser and combing suggested daily
No waterproof mascara or eyeliner with lash extensions, or 48 hours prior to first appointment
No oil based products around the eye area
No pulling, picking or rubbing of the eyelash extensions
No Eyelash Curlers on extensions
No tinting or perming of eyelash extensions

Please check all to confirm an understanding of the aftercare.

I am informing the certified eyelash extension professional of the following conditions that apply to me by marking with a check:

Current use of contact lenses which I may be asked to remove
Current use of eye drops of any kind, prescription or over-the-counter
Current use of any facial products containing oil
Current allergies, sensitivities or history of dry eyes
History of recurrent eye or tear duct infections
Recent history of Chemotherapy
Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions. Listed below:

Single Line Text

I understand the cancellation policy as follows: *

Cancellations must be made prior to 24 hours before scheduled appointment. If cancelled within 24 hours of appointment a cancellation fee will be due immediately.
If I fail to arrive to my appointment and give no notice I will be billed for 100% of the services cost
If I am more than 15 minutes late to my appointment I understand that it will be automatically cancelled and I will be charged accordingly.

Please check each box to confirm you agree to these terms

I understand services are non-refundable. *

I understand

I understand that as I am being a model for a newly certified artist that photos will be taken of my eye area before and after the service for portfolio building. I give Lash Fox Beauty and my lash artist permission to take, publish and reproduce photographs of me, my face, and/or my eye area, both before and/or after the procedure for advertising, training and other purposes. *

I agree

If you would like to be tagged on Social Media please enter your user name(s)

If you have any questions please feel free to leave them here to discuss upon arrival. If you would like to discuss prior to your appointment please note that as well and we will be in touch,

This agreement will remain in effect for all eyelash extension procedures performed at Lash Fox Beauty. I will inform Lash Fox Beauty of any changes applicable to this agreement. I read English and understand that this agreement is legal and binding. I will not hold Lash Fox Beauty or any of its service providers liable for any damages on this day or any day forward. I have read and understand all information in this agreement. I am over 18 years of age and consent to this agreement and to the services rendered.

Client Signature *

Todays Date *