Lash Fox | Lash Fox Beauty Consent Form

Name *

First

Last

Email *

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

Phone *

Birthday //

*Optional* For promo use only

How did you hear about us?

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?

Are you currently pregnant or nursing?

Yes
No

While the majority won’t have a problem with lash extensions, others may find the process to be sensitizing or uncomfortable. Always double-check with your doctor before receiving any services. Please confirm you have read and understand the potential risks of lash extensions while pregnant by checking the boxes below.

Adhesive & Chemical Allergies – During pregnancy and nursing, you may notice your senses are much more reactive. Lash extension services involve a few chemical-based products like adhesive. The lash extension itself does not cause harm, but what can be harmful are the chemicals in the adhesive. Lash glue can potentially cause allergic reactions, and if this was to happen you may be limited on the antihistamines that are safe to ingest. Your doctor must be consulted for this as your lash artist is not a medical professional and cannot provide medical advice.
Poor Retention – Due to the constant hormonal changes during pregnancy and postpartum, there is a chance the lash extensions may shed from the natural lash faster than intended. The natural lashes themselves may also shed faster than your average growth cycle during this time.
Lying Down For Extended Periods Of Time – Once you reach a certain point in your pregnancy, laying down on your back for an extended period is not recommended. This poses a risk because lash extension services have you lay down and close your eyes for up to 3 hours. (Bolsters are available and you are more than welcome to bring your own pillow also)

Allergy Testing

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 a allergy test is highly advised a minimum of 48 hours prior to application.

I consent to an Allergy test. To complete this test a mini lash extension appointment will be preformed including, but not limited to, the application of products used to clean, prime and prep the natural lashes; the application of lash extensions to some of my natural lashes and the use of products to complete the application. I agree to notify Lash Fox Beauty of any irritation, redness, soreness, swelling or concern I have prior to confirming my appointment for full lash extension application. I understand that while the allergy test is an indicator, it is not a confirmation or guarantee that I will not have a reaction in the future. *

I consent
I choose to waive the allergy testing

Only consent if you have booked a consultation more than 48 hours prior to your application appointment. We are unable to provide a allergy test at the same time as application. If you are not receiving a consultation you are choosing to waive the allergy testing.

I hereby waive the 48 hour patch test for Lash Extensions. I acknowledge that I have been advised that I should have a patch test performed, however I choose to waive this test. I choose to have Lash Fox Beauty provide Lash Extension services on me from this day forward, knowing full well that I could have a reaction that may require treatment by a health care professional or even hospitalization. I do not hold Lash Fox Beauty or its employees legally liable or responsible for any outcome that may happen as a result of me waiving the allergy test for this Lash Extension application:

Signature

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

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 must 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 photos may be taken by Lash Fox Beauty of me, my face, and/or my eye area, both before, during and/or after the procedure for insurance, training and other purposes. These photos will not be shared unless consent is provided below. *

I understand

Optional: I give Lash Fox Beauty permission to publish and reproduce photographs of me, my face, and/or my eye area, both before and/or after the procedure

Yes
No

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 *

Lash Fox Beauty Consent Form – Lash Extensions

Allergy Testing

PLEASE READ AND UNDERSTAND THE FOLLOWING: