Eyelash Extension Consent Form Logo
  • Eyelash Extension Consent

    Please fill in the form below.
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    I understand that the eyelash extensions will be applied to the natural lash as determined by the lash specialist to protect the health and integrity of my natural lashes. No more than 2mm-3mm past the natural lash. Diameters including .20mm and .25mm are NOT offered as they are too heavy for wear.

    I understand that lash services have some inherent risk or irritation to the orbital eye area, including the eye itself, and could result in stinging and burning, blurry vision, and potential blindness should the adhesive enter the eye or an allergic reaction occurs.

    I understand as part of the procedure the following may occur to the eye: irritation, pain,  itching, discomfort, and in RARE cases infection.

    I understand and agree that if i experience any of these issues with my lashes that I will contact my lash specialist immediately to have them removed and consult a physician at my own expense.

    I understand that there is a 1 in 3 chance that I will develop an allergy or may already have an allergy to the cyanoacrylate (the main ingredient in all Lash Adhesives).

    I understand that this is a Semi-Permanent procedure, as my natural lashes will continue to grow and fall out normally, making fill appointments necessary to maintain the fullness of the extensions.

    I understand that a fill is required every 2 to 4 weeks depending on my natural lash growth cycle and how well I care for them in between appointments.

    I understand that if I require a fill with less than 35% (or less than 20 per eye) of my extensions remaining, I will pay for a new, full set of extensions.

    I understand the need to follow a strict aftercare regimen to keep my lashes clean and healthy, and that a kit is available to me at a reduced price with my new set. Failure to follow aftercare instructions can cause extensions to fall out prematurely, and may develop bacterial infections causing follicle damage.

    I understand that I must arrive to my appointments with lashes free of debris such as eyeshadow, mascara, strip lash adhesive, eyeliner, moisturizer, etc. or I will have to reschedule my appointment as determined by my tech. The adhesive will not adhere the extensions correctly to the natural lash.

    If my lash specialist needs to spend excessive time cleansing my lashes to prep for a fill or new set, I  will be charged accordingly. $5 to $10 depending on time and product used.

    I understand that it is imperative that I disclose all of the information requested in the health history section.

    I have cited all conditions and circumstances regarding my health history, all medications being taken, and any past reactions to product or medications.

    I understand that additional conditions could occur or be discovered during the procedure which could cause my inability to wear the extensions.

    I consent to “before and after” photographs for the purpose of documentation, potential advertising, and promotional purposes.

    I understand that in order to receive this service, I must keep my eyes closed and remain still and on my back for the duration of the procedure.

    I understand that depending on how many natural lashes I have and the style of set I choose to do, this procedure may take 1.5 hours to 3.5 hours to complete. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have this service performed.

    I understand that every appointment is booked accordingly by a time slot, and agree that if I arrive 10 minutes or later to my scheduled appointment, I will need to reschedule my appointment as determined by my tech.

    I understand that if I must reschedule or cancel my appointment, I will give my lash specialist at least 24 hours notice in advance. Clients that do not give at least 24 hours notice will be required to pay an additional fee (20% of the cost of the appointment that was scheduled) with either the card on file or at their next appointment.


    For New clients coming from other salons, spas, etc:

    I understand that if I am receiving a fill on lashes that are from another salon/spa, there will be a $20 fee in addition to the fill price. If my current lashes that I am receiving a fill on are not properly applied and/or are compromising the integrity of my natural lashes, my lash specialist will not perform a fill, but instead will suggest removal and discuss lash rehab options.

    This agreement will remain in effect for the procedure and all future procedures conducted by my lash specialist for as

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