Client Intake Form for Eyelash ExtensionsSign Form Below! Client Intake Form for Lash Affect Eyelash Extensions I authorize Lash Affect Professional to (check all that apply): Apply eyelash extensions to my natural eyelashes. Remove any eyelash extensions. Retouch my eyelash extensions. By signing this form, I consent to the placement or removal of the eyelash extensions by the certified eyelash extension professional. Please check all. I understand that on rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension professional that performed this procedure and it may be beneficial to have the eyelashes removed. I understand and agree to the after-care instructions provided by the certified eyelash extension professional for the use and care of my eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out or decrease the time the lashes will last. I understand and consent to have my eyes closed and covered for the duration of ____ minute procedure I am informing the certified eyelash extension professional of the following conditions: Current use of contact lenses Current use of oil-containing sunscreen or moisturizer around the eyes. Current use of eye drops (prescription or over-the-counter). Current allergies or sensitivities. History of recurrent eye or tear duct infections. History of dry eyes or Sjorgen's Syndrome. Recent history of Chemotherapy. Other Medical conditions which would prohibit or compromise placement and retention of eyelash extensions. (Please notify us) If answered yes to any of the conditions above, please specify. I agree to the following eyelash extension follow-up and maintenance instructions: (Please Select All) No waterproof mascara. No oil-based products around the eye area. No water can come in contact with the eye area for 24 hours after the application. No tinting or perming of eyelash extensions. No pulling or rubbing of the eyelash extensions. Sign Below: * This form will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. I have read and fully understand all information in this form. I am over 18 years of age and consent to the form and to the eyelash extension application procedure. * First Name Last Name Email * Phone (###) ### #### Name Print Digital Sign * ***I AM AWARE THAT THIS IS A NON REFUNDABLE SERVICE*** Thank you!
