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Eyelash Extension Waiver & Consent Form 


Please read through the following information and conditions before agreeing and accepting the terms


Spot Test:

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.

Lip Blush Tattoo Waiver of Liability 


Please read through the following information and conditions before agreeing and accepting the terms


Waiver of Liability:

I, the client, am over the age of 18 years old, am not under the influence of drugs or alcohol, am not pregnant or nursing, and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.


I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I, the client, understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including, but not limited to: infections, scarring, inconsistent color, flares, spreading, fanning, or fading of pigments. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedure(s) of the lip blush tattoo 


I, the client, understand there is a possibility of an allergic reaction to pigments, anesthetics, and other materials used. A patch test is advisable, however, it does not ensure a client will not have an allergic reaction. If waived, I release the tattoo artist/technician from any liability if I develop an allergic reaction to all the materials used during the process.


I, the client, understand the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand there may be a certain amount of pain associated with the procedure and that other adverse side effects may include minor or temporary bleeding, bruising, redness or other discoloration and swelling. Fever blisters may occur on the lips following lip procedures on individuals prone to this problem. Fading or loss of pigment may occur. Secondary infections in the procedure area rarely occur.


I understand that all instruments that enter the skin/lips or come in contact with body fluids are disposable, and disposed of after use. Cross-contamination guidelines are strictly adhered to. Generally, infections are usual, the area must be kept clean and sanitized, and following strict aftercare provided by my technician


I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures, it may result in an adverse change to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable


Depending on the procedure(s) which I select, I accept full responsibility for determining the color, shape, symmetry, and position of the eyebrows, eyeliner, lips, and/or the color of the camouflage.


I have received pre and post-procedure instructions and will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances of a successful procedure. If I am on any medication for depression or any other mood-altering prescription, I will advise my technician if I have ever had a cold sore I will consult with and strictly follow my doctor’s instructions before contemplating any permanent cosmetic procedure on my lips.


I understand and accept that the PMU procedure is a process, ofter requiring multiple applications of color to achieve desirable results


I understand this procedure will result in a permanent change to my appearance

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