Lash Fox | Lash Fox Beauty Consent Form

Name *

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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 *

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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)

Are you currently pregnant or nursing? *

Yes
No

While the majority won’t have a problem with lash lifts or tinting, others may have less than optimal results. Always double-check with your doctor before receiving any services. Please confirm you have read and understand the potential risks of lash lifts and tinting while pregnant or nursing by checking the boxes below.

Lift may not take - The hormones in our body change drastically and rapidly during pregnancy and postpartum. Due to this the structure of our hair also changes. There is a chance the lash lift or tint may not work on your lashes, and the longevity of the result may also be less than intended.
Allergies – During pregnancy and nursing, you may notice your senses are much more reactive. Lash lift services involve a few chemical-based products which 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.
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. You will be required to lay still for up to 1 hour. (Bolsters are available and you are more than welcome to bring your own pillow also)

Have you ever used hair color before? *

Yes
No

If yes, have you ever had an allergic reaction to hair color? *

Yes
No

Do you wear contact lenses? *

Yes
No

It is highly recommended to remove contact lenses prior to your service. If product gets into your eye contacts will restrict the ability to flush the eye. This is optional, but highly recommended.

I understand

Have you ever had your lashes lifted? *

Yes
No

If you had an adverse reaction to a previous lift, please explain:

When was your last lash lift?

Have you ever had your lashes tinted? *

Yes
No

If you had an adverse reaction to a previous tinting, please explain:

PLEASE READ AND UNDERSTAND THE FOLLOWING:

Each box check provides electronic confirmation & consent

I agree and consent to have an eyelash lift and/or eyelash tint applied to my natural eyelashes and/or retouched. *

I agree
I would like to discuss this further

There are risks associated with having a lash lift and lash tint. As part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases allergic reaction, eye infection, or blurriness could occur. At my request I may have a patch test done at least 24 hours before my appointment. I agree that if at any time, I am uncomfortable with the lash lift and tint treatment, I will inform the technician and she will gladly rectify the problem, including ending the session. *

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

I understand and consent to having my eyes closed for the duration of an approximately 60 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

While every attempt will be made to provide me with my chosen color, everyone’s hair absorbs color differently and the result may not be the color I initially wanted. *

I understand
I would like to discuss this further

It is my responsibility to prepare my eye area prior to arrival. Eyelashes 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

There are no guarantees for the length of time your lash lift and/or lash tint will last. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the lash lift and/or lash tint such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. *

I understand
I would like to discuss this further

I understand and agree to the following after-care instructions for best results and longevity of my lash lift. I realize and accept the consequences of failing to adhere to these instructions may cause the lift to relax and/or decrease the time the lashes will last. *

No water, sweat, steam, saunas or make-up for the first 24 hours
Do not sleep on your lashes for the first 24 hours
Avoid rubbing, or playing with your lashes, resist the temptation to touch
Waterproof mascara may be used, but the removal may decrease the lift. Regular mascara is recommended
It is advised to apply an eye safe oil to the lashes about 3 times a week to keep them hydrated

Please check all to confirm understanding of aftercare

We suggest checking with your doctor prior to having a lash lift and/or lash tint if you: are pregnant, nursing, have chronic dry eye, conjunctivitis, eye infections, trichotillomania, have recently undergone chemotherapy, or have recently had Lasik or blepharoplasty surgery. *

I understand
I would like to discuss this further

I may not be a candidate for a lash lift if I have damaged lashes or lashes with gaps or have extremely short natural lashes. *

I understand
I would like to discuss this further

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 lash lift and/or tinting 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 Lift & Tint

PLEASE READ AND UNDERSTAND THE FOLLOWING: