Eyelash Extension Waiver & Consent Form
Please read through the following information and conditions before agreeing and accepting the terms
If I have any concerns about any possible reactions or irritations to my skin I will contact ELLE M LASHCO. before my initial appointment and arrange a spot test. ELLE M LASHCO. will drop adhesive/adhesive remover for 10 mins. After 10 mins and the product has not reacted to my skin, ELLE M LASHCO will add 2 - 3 individual lashes that will be applied between 24 to 48 hours of my initial appointment and/or apply adhesive behind the ear allowing 24 hours to see if there is any reaction. This agreement will remain intact for this procedure, and all future procedures conducted by ELLE M LASH CO or any other professional services provided by the company of ELLE M LASHCO. I, the client, accept that the agreement is binding upon me, and my heirs, legal representatives, and assigns. I represent that I am over 18 years of age and I have the right to enter into this agreement. If I am under 18 years of age, I have one of my own parents or a legal guardian to give me consent to this agreement.
Waiver of Liability:
I, the client, understand the risk associated with having artificial lashes applied to and/or removed from my existing, natural eyelashes and notwithstanding the utmost of care in the application or removal of these products. There are still risks associated with the procedure and product itself, which include without limitation, eye irritation, eye pain, discomfort, and in rare cases blindness when improperly handled. As part of the procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the lash extensions to my existing eyelashes. Even with the utmost care through a professional, I understand that adhesive material may become dislodged during or after a procedure which may irritate my eyes or require further follow-up care at my own expense to prevent damage to my eyes. I will not attribute any liability to any of the professionals and/or to ELLE M LASHCO and have
accepted the agreement of the terms and conditions.
No known Medical Condition/Informed Consent:
I, the client, have completed the ELLE M LASHCO questionnaire and have explained it entirely and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesive or adhesive remover are a skin, eye, and mucus membrane irritant and that in rare cases persons may be allergic or may have hypersensitivity to synthetics, cyanoacrylate or formaldehyde which in small amounts may be in the adhesive. I understand that the procedure requires that I will try my best to lay still for up to 2 hours with my eyes shut. I further state that I have no medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the ELLE M LASHCO. instructions or these warnings.
After Care & Maintenance:
I, the client, agree to follow the care and maintenance instructions provided by ELLE M LASHCO for the use and care of my eyelash extensions and if any follow-up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my eyelash extensions or may cause my eyelashes to fall out prematurely. Knowing this I agree to follow these tips for best results:
● I will avoid oil-based eye products as these will loosen and break down the bond/adhesive of my eyelash extensions.
● I will avoid getting my eyelash extensions wet within the first 24 hours after my application.
● For the first 2 days after my application. I understand that it is best to avoid swimming, saunas and steam rooms. If I experience any itching or irritation I agree to contact ELLE M LASHCO. immediately to have the lash extensions removed.
● I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tiny in my
eyelash extensions on my own or with any product, but the procedure requires that my eyelash
extensions be professionally removed.
Permission to use pictures:
I, the client, hereby grant to ELLE M LASHCO. the full right to take, publish and reproduce
photographs of myself, my face, my eyes and/or eyelashes both before and after this procedure,
for any advertising, educational or other purposes whatsoever, including the right to retouch
these photographs as deemed necessary by ELLE M LASHCO, I assign any copyright in these
photographs to ELLE M LASHCO. I also grant my consent for ELLE M LASHCO. to use my
image and likeness as contained in these photographs for any advertising or other purposes,
along with any comments I may provide.