Consent form - Lash lift - Lashes by Tini

Name

Telephone number

Address

Date of birth *

Date

Email

[email protected]

Name of technician

Have you ever had an eyelash enhancement? *

Yes No

If so, have you had a good experience? *

Yes No Not applicable

Do you wear contact lenses? *

Yes No

Have you had recent eye surgery? *

Yes No

In the past few months, have you had an eye infection or injury? *

Yes No

Are you taking any medication? If so, name them:

Are you allergic to latex or rubber? *

Yes No

Are you intolerant to chemical or hypersensitive ingredients? *

Yes No

Are you allergic to glues, tapes or bandages? *

Yes No

Do you use serums or conditioners for lash growth? *

Yes No

Have you ever had your eyelashes tinted? *

Yes No

Are you comfortable lying down for 1-2 hours without discomfort? *

Yes No

Do you have seasonal allergies? *

Yes No

The technician explained to me what the eyelash enhancement and eyelash tinting technique is all about, the care that needs to be taken at home to keep them healthy and the potential risks if neglected. The information on this form is accurate. I have not misrepresented or withheld any medical information, surgical condition or condition.

I understand that irritation, pain, itching and discomfort to the eyes and, in rare cases, eye infection may occur in connection with the procedure.

I understand and agree to contact my technician if I experience any of these problems with my eyelashes and to consult a physician at my own expense if necessary.

I understand that an allergic reaction cannot be controlled by the technician and I therefore release her from all responsibility.

I understand and agree to follow the aftercare instructions given by the technician.

I understand that I will have to keep my eyes closed during the 60 to 120 minute procedure. I also understand that I will have to lie down for this period of time.

I allow my lashes to be curled with advanced solutions and dyed with a black eyelash tint.

I agree that in very rare cases, with the natural growth cycle of the lashes, the lashes could curl in several directions.

I agree to avoid water, steam and mascara + avoid sleeping on the lashes for 48 hours after the treatment. I understand that not following these instructions will cause undesirable results.

I agree not to use products containing oil (mascara, makeup remover or cream) on an eyelash enhancement.

I agree that there is no guarantee on the result or hold of the eyelash enhancement.

This agreement will remain in effect for this and all future procedures conducted by my technician Sarah Stamm.

I have read and understood all of the above information.

I allow the technician to take pictures of my eyes before and after the procedure.

COVID-19

I hereby certify that I do not have or have had any symptoms associated with the COVID-19 in the last 14 days. This includes: fever, cough, shortness of breath, muscle aches, loss of smell or taste, diarrhea, nausea or sore throat.

You acknowledge that the extreme sanitary measures in place cannot guarantee complete protection against COVID-19.

I acknowledge that by making an appointment, I accept all responsibility for the possibility of contracting the COVID-19.

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By signing below, I acknowledge that I have read and understood all of the above and that I fully consent to it.

Signature of the technician: ________________________________________________________________.

Client's signature: *

Clear

Date

Consent form - Lash lift

Customer file - Lash Lift

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