eyelash extension consent Form

Name *

First Name

Last Name

Phone *

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Birthday *

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I agree to have individual eyelash extensions applied to my natural eyelashes and/or removed and retouched. By checking this agreement, I consent to the placement and removal of eyelash extensions by Lashes by Shelby. *

Agree

I understand there are risks associated with having artificial eyelash extensions applied to, or removed from my natural eyelashes. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection can occur. I agree that if I experience any of these medical conditions with my lashes I will contact Lashes by Shelby and have the eyelashes removed immediately and consult a physician at my own expense. I understand that even though Lashes by Shelby, applies and removes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow up care and subsequent removal of eyelash extensions. *

Agree

I understand and agree to the care instructions provided by Lashes by Shelby for the use and care of my individual eyelash extensions. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out, damage the extensions and/or decrease the longevity of the lashes. *

Agree

I am informing Lashes by Shelby, of the following conditions by marking with a check: *

Current use of contact lenses which I agree to remove during eyelash extension application

Current use of eye drops of any kind, prescription or over the counter

Current use of anything such as oil-containing sunscreen or moisturizers around the eyes

Current allergies or sensitivities to any instruments, fumes, tapes, cleaners, eye gel pads, adhesives and removers that could cause my eyes to water or blink excessively

History of recurrent eye or tear duct infections

History of dry eyes, Sjogren’s Syndrome or Claustrophobia

Recent History of Chemotherapy

Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions

None of the above apply

I agree to the following eyelash extension post-op and maintenance instructions: *

1. No waterproof mascara 2. No prescription or over-the-counter eye drops 3. No oil-based products around the eye area 4. No water can come in contact with the eyes for 24 hours following the application 5. No tinting or perming of the eyelash extensions 6. No continuous pulling or rubbing of the bond/eyelash extensions

Agree

This agreement will remain in effect for the procedure and all future procedures conducted by Lashes by Shelby. I read English and understand that this consent form is legal and binding. I have read and fully understand all of the information in this agreement. I am over 18 years of age and consent to the agreement. *

Agree

I release my technician (Lashes by Shelby) from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There is no guarantee for the bonding time of the eyelash extensions. I understand the aftercare instructions and will do my part to maintain my eyelash extensions. I understand that there are many factors that may affect the life of eyelash extensions such as water and moisture contact, weather conditions and activities involving exposure to high temperatures. *

Agree

In the case that I am not satisfied with my eyelash extensions enhancement provided by Lashes by Shelby, I agree to immediately contact Shelby regarding the issue. In the event that I am not satisfied with my results, I agree not to publicly defame Lashes by Shelby on any online or social media networks ie. Facebook, Twitter, Pintrest, Instagram, TikTok, Google or Yelp prior to consulting Shelby Savage. Doing so is prohibited and we will seek legal action against your disputed claim. *

Agree

Permission is granted to take before and after photos of my eyes/face which may be used for marketing purposes on a websites, salons or classes. *

Agree

By signing below, I verify that I have read and understand the above statements and agree to them. *

First Name

Last Name

Date *

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DD

YYYY