Eyelash Extensions Agreement and Consent Form
Full Name: ____________________________________________
Referred by: ___________________________________________
_____ I understand that this procedure requires single synthetic eyelashes to be glued to my own natural
_____ I understand that it is my responsibility to keep my eyes closed and be still during the entire
procedure, until my eyelash technician addresses me to open my eyes.
_____ I understand that some risks of this procedure may be but not limited to eye redness and irritation.
The fumes from the adhesive may cause my eyes to tear up if I open my eyes.
_____ I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.
_____ I understand that I am required to follow the eyelash extension care sheet (attached hereto) in order
to maintain the life of these extensions.
_____ I agree that by reading and signing this consent form, I release Shiori Kitazono and Fabulous Skin &
Lash from any claims or damages of any nature.
_____ I agree that I read and fully understand this entire consent form.
_____ I am of sound mind and fully capable of executing this waiver for myself.
_____ I give Shiori Kitazono and Fabulous Skin & Lash permission to show my before and after photos of
eyelashes to other potential clients Yes _____ or No _____
_____ I have read and completed the Eyelash Extensions Intake & Consent form in its entirety, and have
answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that may be caused by the application and/or removal of Eyelash Extensions.
I confirm and agree that I wish to engage the services of Shiori Kitazono and Fabulous Skin & Lash to apply eyelash extensions.
Print Your Name: _____________________________________________________
Eyelash Extension After care
Eyelash extensions are not for everyone. This is a very high maintenance beauty treatment. It requires very gentle care in order for the lashes to last long and stay in good condition. Once the lashes are attached you must not rub or pull on them. You must not wear any mascara or use Eyelash curlers. You should read and understand all the information listed below, and sign the form before you get this service done.____ (initial)
What are Eyelash Extensions?
Eyelash Extensions are individual Synthetic material. They are attached to your Eyelash individually not to the skin. Each synthetic lash is attached to an eyelash. It is a very enhancing beauty service and you DO NOT need to use any Mascara while wearing these Eyelash extensions. It is a very careful and intense service which requires skill and preci- sion. Once applied these lashes are so natural looking it is difficult to tell even up close that you have extensions on. Size availability ranges from short to long.___ (initial)
How long do the Eyelashes last?
It is an individual process. We lose one Eyelash almost everyday. We also grow a new lash to replace the one that fell out. These Lashes can stay on up to 2 full Months with proper care and maintenance. However, factors such as eye- lash growth, lifestyle and general after care will affect how long the lashes last. Please do not attempt to remove any lashes on your own, seek professional help from your technician. WE WILL NOT BE HELD LIABLE FOR ANY DAMAGE THAT YOU MAY CAUSE BY TRYING TO REMOVE THE EYELASH EXTENSIONS ON YOUR OWN.
Do the False Eyelashes damage my natural Eyelashes?
No, not at all! The Lash adhesive is formulated to create a solid bond, specifically for human lashes. The adhesive dries very soft on the lashes, allowing the lashes to stay flexible and bouncy just like your own lashes.
Before Your Appointment
What you should do before your Eyelash Extension appointment.
Remove all eye makeup and clean your lashes with mild, oil free cleanser. Do not use oil based makeup removers to clean your lashes prior to the application. Do not put on any mascara. We don’t want to spend time cleaning your lashes. We’d rather spend time working on perfecting your lashes. If you are a contact lens wearer, please remove contact lenses and wear glasses to your appointment, or bring a lens case and remove them when you arrive at your appointment. Plan to set aside 1 to 2.5 hours for your appointment. Some of our clients fall asleep during the proce- dure. ____ (initial)
1.Do not perm or Tint lashes before or after lash extension application.
2.Do not use a regular Eyelash curler.
3.Do not rub your eyes or lashes when washing your face. Clean around the Eyes with a wash cloth.
4.Do not pull your lash extensions, as it will take out your own lash as well
5.Do not go in a Sauna while wearing Eyelash extensions.
6.Do not use Mascara
7.Do not try to remove the Extensions on your own.
8.Do not cut the Extensions (you may cut your own lashes)
9.Clean your eye make up without touching the Extensions
10.Remember to come in for touch ups.
What happens if a lash should loosen or become dislodged?
Do not pull on the lash. Please contact your Technician to make an appointment to have them removed or replaced, to avoid damage to your natural lash. As your natural lashes fall out due to the growth cycle, you will need refills when new lashes grow. At first you may find you need a refill every 2 weeks. As you become accustomed to the exten- sions and with a little practice maintaining the lashes, the time between refills can be extended to 3-4 weeks.