Lash Form | Fearless Femme Beauty Company

FFBC

Lash Consent Form

Client Information

Full Name

Birthday

Month

Day

Year

Health History

Which of the following services have you had done in the PAST?

Lash Lift / Tint

Lash Extensions

Neither

How did that experience go?

Do you wear contact lenses?

Yes

No

You will need to remove contacts prior to service.

I can provide small glass jars and contact solution for storage during the service. Please bring a secondary pair or wear glasses, if preferred.

Do you have any allergies, especially to ingredients in cosmetics or adhesives?

Yes

No

Unsure

If yes or unsure, please specifiy:

If you have had a reaction to any adhesives, perm solutions or tint/dye, please be sure to explain what happened.

Have you had any previous eye treatments or surgeries?

Yes

No

If yes, please specify:

Are you currently taking any medications, vitamins/supplements?

Yes

No

If yes, please specify:

Have you been diagnosed with any autoimmune disorders, eye or skin conditions, or have undergone medical treatments?

Yes

No

(ex: hypothyroidism, dry eyes, allergies, rosacea, eye infections, chemotherapy)

If yes, please specify:

Lifestyle

Do you drink caffeine regularly?

Yes

No

PLEASE DO NOT DRINK ANY WITHIN 5 HOURS PRIOR TO YOUR APPOINTMENT.

THIS INCLUDES: COFFEE, TEA, CHOCOLATE, PREWORKOUT, ENERGY DRINKS AND SODA.

IF ABSOLUTELY NECESSSARY, PLEASE KEEP THIS TO A MINIMUM.

Rapid involuntary eye movements are dangerous for the guest and will require rescheduling the service with associated cancelation fees.

Do you:

use saunas

exercise

sweat excessively

have oily skin

Selecting any of the above will require additional lash cleansing for extensions for best retention, but does not necessarily prohibit you from having them. Please refrain any of the above as much as possible within 24-48 hours post service.

Is skincare important to you?

Absolutely

Not really

PRO TIP: If you wash your face in the shower typically, try doing so out of the shower and wiping product away with a towel to avoid getting onto lash extensions.

AVOID OIL BASED PRODUCTS AROUND THE EYES.

Medical grade, clean, lash extension safe skincare can be purchased through a third party website/brand. Ask your artist for more info!

Do you wear makeup on a daily/regular basis?

Yes

No

Sometimes

Avoid waterproof or oil based makeup of any kind with extensions. This could be liner, mascara, eyeshadow, concealer and foundation. Bottom mascara that

is lash extension safe is available for purchase at your appointment.

Procedure Understanding and Consent

I consent to the following services being performed by FFBC: (Check all that apply)

Lash Lift and / or Tint

Lash Extensions

I understand that the application of lash extensions and the performance of lash lift and tint procedures involve the use of adhesives and other products that may cause irritation or allergic reactions.

I acknowledge that results may vary based on individual factors, and no guarantees have been made regarding the outcome.

I agree to follow all pre-procedure and aftercare instructions provided by FFBC to ensure the best results and minimize potential risks.

I consent to the use of photographs or videos of my lashes for promotional purposes, understanding that my identity will remain confidential unless otherwise agreed upon.

Client Acknowledgment

I have provided accurate and complete information to the best of my knowledge.
I have had the opportunity to ask questions and discuss any concerns regarding the procedure and before / aftercare instructions.
I consent to the application of lash extensions and the performance of lash lift and tint procedures as described above.

Liability Waiver

I, the undersigned, release Fearless Femme Beauty Company, its employees, and contractors from any liability associated with the lash extension and lift and tint procedures, including but not limited to allergic reactions, eye irritation, or damage.

Signature

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Date

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