Eyelash Extension Agreement & Consent Form

Name: _______________________________________________________

Date: _____________________________

Cell:_________________________ Work:__________________________

Home Address:__________________________________________________________________ City:___________________________State:____________Zip: _____________________

Email:____________________________________________________________________

Referred by: _____________________________________________________________

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! ACKNKOWLEDGEMENTS

I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes. 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 are not limited to eye redness, swelling of eyelids and irritation. The fumes from the adhesive may cause my eyes to water 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 in order to maintain the life of these extensions. I agree that reading and signing this consent form, I release Heather Gutier for 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.

The undersigned confirms receiving, reading and reviewing with the technician the attached Consent Form which forms part of this agreement, I confirm and agree that I have read the above language, warnings, questions & answers and after care instructions and wish to engage Heather Gutier and/or Kaitlyn Willey to place my eyelash extensions.

Client Signature: _______________________________________________________

Date: _______________________________

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! ! Instructions to follow prior to your eye lash extension

appointment? Eyelash extensions are not for everyone. This is a high-maintenance beauty treatment that requires gentle care for the lashes to remain in good condition and be long-lasting. Once the lashes are attached, you must not rub or pull on them. You must not wear any mascara other than that recommended by your technician. You must not use lash curlers. Please read and understand all the information listed below and sign the form prior to having this service preformed. Wear no mascara, and have clean lashes using a mild-oil free cleanser. Do not use oil based makeup remover prior to the eyelash application. Do not put on any mascara prior to your appointment. Plan to set aside 11⁄2 - 2 hours for your initial appointment. _______ Initial What are eyelash extensions? Eyelash extensions are individual Synthetic, Mink and/or Silk eyelashes. They are attached one-by-one to each of your individual natural lashes – not to the skin. This service is beauty enhancing and eliminates the need to wear mascara. It is a meticulous service which requires the skill and precision of your certified lash technician. Once the eyelash extensions are applied, they are natural looking. Size availability ranges from short to long which will be decided and agreed upon with your certified eyelash technician. How long will my eyelash extensions last if I follow the proper care instructions?

In some cases, eyelash extensions can last up to 4 weeks. However, it is common to get a touch up after 2 - 4 weeks. Like all hair, there are 3 phases to the eyelash growth cycle. There are lashes in each phase at all times, therefore, some will be lost within a couple of weeks, and others can last much longer as part of the natural cycle.

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! ! How much do they cost and how long is the appointment? The initial cost for the eyelash application is $_________ for a full set, this appointment is 90 minutes. Your maintenance appointment known as a fill is $_________ and takes an hour. Please do not attempt to remove your lashes yourself; please seek assistance from your eyelash technician. If you choose to have them removed the appointment is typically 30 minutes at a cost of $35.00. We will not be held liable for any damage that you may cause by trying to remove your eyelash extensions on your own. _______ Initial Do Lash extensions damage my natural lashes? No. When extensions are applied correctly they will not harm your natural lashes; each lash extension is adhered to one single natural lash, the extension will grow out naturally as your own lash matures. The eyelash 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. I have read the above information and agree to continue with the eyelash extension service. ______ Initial As your natural lashes grow and fall out due to the natural growth cycle, you will need refills. It is important to have 75% of the extensions on your lashes in order to maintain the desired clean, full consistent look. Recommended fills are every 2 - 4 weeks. ________ Initial

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! ! ! ! Home Care for your eyelash extensions; please review and follow these recommendations.

For the first 48 hours and long term care of your lashes please:

! Do not allow lashes to get wet.

! Avoid steam – so no spas, saunas, hot tubs, hot yoga, or cooking in a steamy kitchen. Steam will affect the adhesive from bonding properly.

! Do not swim

! Do not rub your eyes or lashes when washing your face – cleanse around the eyes with a wash cloth, or Q-tip

! Do not pull on your lash extensions – as you’re likely to pull out your natural lash with it

! Do not use mascara on your lashes other than the one recommended by your technician

! Do not use a waxy, greasy, or oil based eyeliner or eye shadow during and beyond the first 48 hours, this compromises the adhesive and will result in lash extension loss.