Eyelash Extension Consent Form

agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional listed below.

I understand that in rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or
removed from my natural eyelashes. I further understand that in rare cases as part of the procedure or after application eye or skin irritation
and discomfort may occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension
professional that performed this procedure and that it may be necessary to have the eyelash extensions removed.

 I understand and agree to the after-care instructions provided by the certified eyelash extension professional for the use and care of
my eyelash extensions. I understand that if I request application of eyelash extensions beyond the recommended application advice of the
certified eyelash extension professional I do so at my own risk. I realize and accept the consequences of failure to adhere to these instructions
may cause damage to my own natural lashes and cause the eyelash extensions to fall out and/or decrease the time the eyelash extensions
will last.

 I understand and consent to having my eyes closed and covered for the duration of the application which can be approximately 60-
120 minutes. Times may vary depending on the type and number of eyelashes applied.


I am informing the certified eyelash extension professional of the following conditions by marking with a check:

Please list any other medical conditions, if applicable, which would prohibit or compromise placement and retention of
eyelash extensions

If you’ve checked any of the above, please list here:

This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional
listed below. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information
in this agreement. I am over 18 years of age and consent to this agreement and to the eyelash extension application procedure.

Clients Full Name:





Leave this empty:

Signed by Jameelah Lloyd
Signed On: October 13, 2018

Spa Shal'vah https://spashalvah.com
Signature Certificate
Document name: Eyelash Extension Consent Form
Unique Document ID: f0a9f15aee285c17d8c36dda1477ecc4da9ad14e
Timestamp Audit
October 13, 2018 6:35 pm GMTEyelash Extension Consent Form Uploaded by Jameelah Lloyd - info@beautyboxsf.com IP