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Full Name:
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Email
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Email
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Phone Number:
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Emergency Contact
Full Name:
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First
Last
Phone Number:
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Have you ever had a Lash Lift & OR Brow Lamination Services done in the past?
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Yes.
No.
If YES, tell us about your service:
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When did you receive services? How was your experience? Healing? Any allergic reactions?
Are you currently using any Retinols, Retin-A's, glycolic acids, salacyclic acids, or any other Acne Treatment products?
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Yes.
No.
If YES, tell us more...
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Do you wear contact lenses?
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Yes.
No.
Have you received a recent cosmetic tattoo procedure on your lashes or brows?
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Yes.
No.
If YES, tell us more:
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When did you receive services? How was your experience? Healing? Any allergic reactions?
Are you currently using eye drops of any kind? Over-the-counter or prescription?
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Yes.
No.
Do you have a history of reoccurring eye or tear duct infections?
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Yes.
No.
Do you have sensitive eyes?
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Yes.
No.
Do you have a history of dry eyes or Sjorgen's Syndrome?
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Yes.
No.
I understand that there are risks associated with having an eyelash lift + tint, and or a brow lamination + tint.
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Yes, I understand.
Please share any additional concerns:
Although every precaution will be taken to ensure your safety and well-being before, during, and after your service please be aware of following information and risks.
I understand that as a part of the procedure eye irritation, eye pain, eye itching, discomfort, and in very rare cases eye infection or blurriness may occur. For Brow Laminations skin irritation or itchiness may occur at or around the site in events of hypersensitivity to product or due to medications currently being used at home topically or internally.
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Yes, I understand.
I agree if I experience any of these symptoms listed above, I will consult with my technician immediately; If I choose to consult a Physician it will be at my own expense.
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Yes, I understand.
I understand that the supplies/products used during this service may require a physician's follow up care, even though my technician utilized correct techniques and followed proper safety protocols
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Yes, I understand.
I understand that an eyelash lift will lift my current natural lashes. Depending on my natural eyelash length & strength results may vary per client. upplies/products used during this service may require a physician's follow up care, even though my technician utilized correct techniques and followed proper safety protocols (copy)
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Yes, I understand.
I understand and agree to the care instructions provided to me by my technician before & after my service. I recognize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay as lifted as long as originally told.
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Yes, I understand.
I understand and consent to having my eyes closed and covered for the entire duration of the service (FOR LASH LIFTS.)
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Yes, I understand.
I understand, acknowledge, and agree to before and after photos taken during and after the service for documentation of the provided service(s). I understand that these photos will be used for social media purposes in a professional manner that upholds the integrity to both client and provider. Photos taken may show more than just the treated area such as a the full face.
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Yes, I understand.
This agreement will remain in effect for this service conducted by my technician. I have read the above information and instructions. If I have any concerns, I will address this with my technician before the service is performed. I give permission to my technician to perform the eyelash lift & tint service. I agree that this consitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.
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Yes, I understand.
NO WATER/LIQUIDS CAN COME IN CONTACT WITH THE EYE OR BROW AREA FOR 24 HOURS AFTER THE SERVICE. NO PRODUCTS SHOULD BE USED ON THE LASHES OR BROWS FOR A 24 HOURS AFTER THE SERVICE OTHER THAN PRODUCTS GIVEN TO YOU BY YOUR ARTIST.
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Yes, I understand and comply.
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