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Eyelash Extensions Consent Form

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Eyelash Extensions Consent Form

Consent Form, Intake Form, Liability form, Picture Waiver

Page 1

Consent Form

Email*

Full Name*

Phone Number*

Address*

City*

State*

Zip Code*

Date of Birth*

Emergency Contact Name*

10.

Emergency Contact Phone Number*

11.

Occupation*

12.

How did you hear about us?*

13.

Please check the following:*

I am not pregnant

I am not currently breastfeeding

I am not under the influence of drugs or alcohol

I am not undergoing chemotherapy

14.

Please list any allergies or...

15.

Please list any medications ...

16.

Please list any previous eye...

17.

Please check the following:*

I understand that eyelash extensions are not permanent and will require maintenance

I understand that there are risks associated with eyelash extensions, including but not limited to eye irritation, eye pain, and eye infection

I understand that I must follow the aftercare instructions provided by the technician

18.

Signature*

Description:Ensure a safe and comfortable eyelash extension experience with our consent form. This form includes an intake form, liability form, and picture waiver to ensure that both you and your technician are on the same page.

Before getting eyelash extensions, it's important to fill out a consent form to ensure that you and your technician are on the same page. Our consent form includes an intake form to gather information about your health and any allergies you may have, a liability form to protect both you and your technician, and a picture waiver to allow your technician to take before and after photos. By filling out this form, you can ensure a safe and comfortable eyelash extension experience. Our form is easy to fill out and will give you peace of mind knowing that you and your technician are on the same page.

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Patient's Date of Birth*

Patient's Gender*

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Patient's Full Name*

Patient's Date of Birth*

Patient's Gender*

Preview

Patient Privacy Protection Form

Ensure patient confidentiality with our Patient Privacy Protection Form. This form is essential for hospitals, clinics, and other healthcare organizations to protect the privacy of their patients.

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Full Name*

Membership Number*

Date of Request*

Select date

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First Name*

Last Name*

Phone Number*

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Full Name*

Address*

Phone Number*

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Full Name*

Address*

Phone Number*

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Student Name*

Grade Level*

Teacher's Name*

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