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Home
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Eyelash Extensions
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WHAT ARE YOU LOOKING FOR TODAY?
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Elite Lashes Alamo Ranch Consent
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Elite Lashes Alamo Ranch Consent
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Name
*
First
Last
Date
*
Phone
Email
How did you hear about us?
Relative
Friend
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Google Search
Facebook/Ads
Instagram/Ads
Nextdoor
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Section 1
*
I have agreed to have eyelash extensions applied to my natural eyelashes by ELITE LASHES & MED SPA LLC therapists. Before my eyelash professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.
Section 2
*
I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes.
Section 3
*
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.
Section 4
*
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.
Section 5
*
I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.
Section 6
*
I understand that I am required to follow the eyelash extension care sheet (PLEASE ASK FRONT DESK FOR AFTER CARE CARD) in order to maintain the life of these extensions.
Section 7
*
I agree that by reading and signing this consent form, I release ELITE LASHES & MED SPA LLC therapists from any claims or damages of any nature.
Section 8
*
I agree that I read and fully understand this entire consent form
Section 9
*
I am of sound mind and fully capable of executing this waiver for myself.
Section 10
*
I agreed No refund for any reason, under any circumstance. You are paying for artist time, product and other expenses used to provide you with a service. No refunds will be given for any reason on services or products.
Waiver of Liability 1
*
I understand there are risk associated with having artificial eyelash extensions applied to and/or removed from my natural eyelashes, and that notwithstanding the utmost of care in the application or removal of these products, there still exists risks associated with the procedure and products itself, which include, without limitation, eye irritation, eye irritation, eye pain, discomfort, and in rare case blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach artificial eyelashes to my natural eyelashes. Even though the eyelash extension professional may apply or remove the artificial eyelash properly. I understand adhesive material may become dislodged during or after the procedure, which may irritate eye or require follow up care, at my own expense to prevent damage to my eyes. I also agree to defend, indemnify and hold harmless ELITE LASHES & MED SPA LLC from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fee which might be asserted against them as a result of my having this procedure performed.
Waiver of Liability 2
*
I covenant not to make or bring any such claim against any Release and forever release and discharge all Releases from liability under such claims. All matters arising out of or relating to this waiver and release shall be governed by and construed in accordance with the internal laws of the United States without giving effect to any choice or conflict of law provision or rule (whether of the United States or any other jurisdiction). Any claim or cause of action arising under this waiver and release may be brought only in the federal and local courts located in the United States and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the balance shall continue in full legal force and effect. I further agree that if this waiver and release is not valid in the United States, it shall be construed as a covenant not to sue anytime, anywhere and for any reason. I am signing below stating that i fully comprehend everything stated to me in the WAIVER OF LIABILITY
Signature for Waiver of Liability 1 & 2
*
Clear Signature
No know medical conditions/ informed consent
*
I have read and completed ELITE LASHES & MED SPA LLC client intake form in it’s entirely and in truth. I acknowledge that I have been advised of the potentially harmful or negative side effects that the eyelash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up 3 hours or longer with my eyes closed, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no know medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to ELITE LASHES LLC instructions or these warning.
Permission to use pictures
*
I hereby grant ELITE LASHES & MED SPA LLC therapists the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after the procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by ELITE LASHES LLC therapists. I further expressly assign any copyright in these photographs to ELITE LASHES LLC. I also grant my consent for ELITE LASHES LLC therapists to use my images and likeness as contained in the photographs, along with any comments I may provide.
I wish to engage
*
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 ELITE LASHES LLC therapists to apply eyelash extensions.
Full Name
*
Clear Signature
Signature
*
Clear Signature
Signed On:
*
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