Eyelash Extension Consent

Informed Consent & Liability Agreement

Please review and complete the following form before your appointment. All fields marked with * are required.

Client Information

Full Name *

Phone Number *

Email Address *

Date *

1. Informed Consent for Eyelash Extension Services

I understand that eyelash extension services involve the attachment of individual synthetic fibers to my natural eyelashes using a professional-grade adhesive containing cyanoacrylate.

I acknowledge and understand the following:

• The procedure requires me to lie down with my eyes closed for approximately 1.5–3 hours.
• Minor redness, irritation, tearing, or sensitivity may occur temporarily.
• There is a risk of allergic reaction to adhesives, gel pads, tapes, cleansers, or other products used during the service.
• Results and retention vary based on individual lash growth cycles, lifestyle, and adherence to aftercare instructions.

I voluntarily consent to receive eyelash extension services from Passion for Lashin Studio & Co.

I have read and understand the informed consent for eyelash extension services. *

2. Health Disclosure

I certify that I do not currently have any eye infection, inflammation, styes, conjunctivitis (pink eye), or other contagious eye condition. I have fully recovered from any recent eye surgery or procedure. I do not have a known allergy or sensitivity to cyanoacrylate, acrylates, or lash extension adhesives.

If any of the following apply, please check below:

I understand that failure to disclose medical conditions may increase risk and release the provider from liability related to undisclosed information.

3. Acknowledgment of Risk & Release of Liability

I understand that although all products and procedures are applied with care and professional standards, unforeseen reactions may occur.

I agree to release and hold harmless Passion for Lashin Studio & Co. and Nicole Schmidt from liability for:

• Allergic reactions
• Irritation or swelling
• Lash loss due to normal shedding cycles
• Complications arising from undisclosed medical conditions
• Failure to follow aftercare instructions

I acknowledge that I am receiving this service voluntarily and accept full responsibility for any outcomes associated with my individual sensitivities or aftercare compliance.

I acknowledge the risks and release Passion for Lashin Studio & Co. from liability. *

4. Aftercare Responsibility

I understand that proper aftercare is required to maintain lash health and retention, including:

• Avoiding oil-based products around the eye area
• Gently cleansing lashes as instructed
• Avoiding pulling or rubbing extensions
• Scheduling fills every 2–3 weeks

I understand that neglecting aftercare may result in premature lash loss or damage to natural lashes.

I understand my aftercare responsibilities and will follow the provided instructions. *

5. Appointment & Cancellation Policy

I understand and agree to the following policies:

• A minimum of 24 hours' notice is required to cancel or reschedule an appointment.
• Cancellations with less than 24 hours' notice may be subject to a cancellation fee.
• No-shows may be charged up to 100% of the scheduled service.
• Clients arriving more than 15 minutes late may need to reschedule and may be subject to a fee.

I understand these policies are in place to respect scheduled time and maintain professional standards.

I have read and agree to the appointment and cancellation policy. *

6. Photography Consent (Optional)

I grant permission for photographs of my lashes to be used for marketing and portfolio purposes. Full-face images will not be used without additional consent.

I grant permission for photographs to be used for marketing and portfolio purposes.

Client Agreement

By signing below, I confirm that:

• I have read and understand this agreement in full.
• I have had the opportunity to ask questions.
• All information provided is accurate to the best of my knowledge.
• I voluntarily consent to receive eyelash extension services.

Printed Name *

Client Signature *

Draw your signature above