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3D LASH & BROW
Salon & Academy

469 - 917 - 9305

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3D Lash & Brow Salon & Academy

Eye Lash Extension consent form

First Name

Last Name

Phone

Address

How did you hear about us?

Have you had Eye Lash Extensions before?

Please list all your Allergies

By checking each field, you agree to said statement

I am at least 18 years of age

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 & be still during the entire procedure, until my eyelash technician directs 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 surgical tapes, cyanaocrylate, and other acrylates, etc.

I understand that I am required to follow the eyelash technician aftercare sheet (below) in order to maintain the life of these extensions.

I agree to wait a minimum of 24 hours before getting my lash extensions wet to allow glue to properly cure.

I agree that by reading and signing this consent form I release the lash technician and 3D Lash & Brow Academy from any claims or damages of any nature.

I agree that I read and fully understand this entire consent form.

I give permission to show my before and after photos of my lash extensions to other potential clients, or use for marketing purposes

I have read & understand the Eyelash Extension Aftercare sheet & the Eyelash Extensions Intake & Consent form in its entirety. I have given permission to all checked statements & 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 understand & agree that if I have any concerns, I will address these with my lash artist. I confirm & agree that I wish to engage the services to apply eyelash extensions.

By typing my full name in the box below I agree to all statements checked above and have agreed to extensions services.

Select a date

Thanks for submitting!

469-917-9305

4230 LBJ Freeway, Suite 122

Dallas, Texas, 75244