Lash / Brow Tint Consent Form
First Name
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Last Name
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Email
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I understand there are risks associated with having my eyelashes and/or eyebrows lifted and/or tinted. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases, eye infection or blindness can occur. I agree that if I experience any of these medical conditions, I will contact the certified professional esthetician and consult a physician at my own expense. I understand that even though the professional esthetician applies or removes the lifting or tinting solution 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.
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Yes, I understand.
I understand and agree to the care instructions provided by the certified professional esthetician for the care of my eyelash/eyebrow lift. I realize and accept the consequences of failure to adhere to these instructions may cause a decrease in the time the lift will last.
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Yes, I understand.
I agree to remove contact lenses (if applicable) prior to receiving a lash lift.
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Yes, I understand.
Please indicate if you have any of the following conditions:
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Allergies or sensitivities to fumes, tapes, cleaners, eye gel pads, adhesives, or removers
History of recurring eye or tear duct infections
History of Sjorgen’s Syndrome
Recent Chemotherapy
Other medical conditions which would prohibit or compromise the service
None of the above
I agree to the flowing eyelash/eyebrow lift post-op and maintenance instructions: Do not apply makeup or receive any other eye treatments for at least 24 hours after treatment. Avoid swimming/sauna and keep lashes/brows dry for at least 24 hours. Comb lashes upwards using mascara wand. Use lash/brow conditioner daily. Avoid putting contact lenses on for the rest of the day after lash treatment. Avoid over touching lashes/brows after treatment.
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Yes, I agree.
I release my technician or salon 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 time results of the service will last. This salon is not responsible for any technician errors. I understand the aftercare instructions and will do my part to maintain my eyelash/eyebrow lift. I understand that there are many factors that may affect the life of the lift and/or tint.
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Yes, I agree.
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Client Signature
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