Your Certified Lavish Lashes® Specialist is:
Appointment Date and Time:
Location of Service:
How did you hear about us?
Lavish Lashes WebsiteAdvertisementGoogle/web searchFriendOther:
Please indicate if you have recently worn or frequently wear any of the following types of lashes?
individualstripflareeyelash extensions Brand used?
Generally relating to the skin:
Permanent eye make-upBlephroplasty (eye-lift)Blepharitis (inflammation of eyelids)Allergies to adhesives found in bandaids or medical tapeAllergies to cyanoacrylate adhesives (i.e. surgical glue, nail glue, crazy glue) or hypersensitivity to formaldehyde (a by-product released in such adhesives)Retinoids used to treat acne and skin problems (such as Accutane or Retin A)
I understand that the items I have checked above may increase the risks involved in having eyelashes applied and/or removed and do hereby give my consent for the procedure. I further agree to inform my Lash Stylist if any of the above conditions have changed prior to proceeding with the service in any future appointments:
For Lash Stylist to Complete
I have agreed to have Lavish Lashes® eyelash extensions applied to and/or removed from my eyelashes. Before my qualified professional can perform
this procedure, I understand I must complete this Agreement and provide my informed consent by signing and dating where indicated below.
For valuable consideration, in order to have my Lavish Lashes® eyelash extensions applied and/or removed from my eyelashes:
1. Waiver of Liability. I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes,
and that notwithstanding the utmost of care in the application or removal of these products, there still exists 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 this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial Lavish Lashes® to my existing eyelashes. Even though the Professional may apply or remove my Lavish Lashes® properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying Lavish Lashes® to my eyelashes, and I will not attribute any liability to Professional or Lavish Lashes® as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless Professional and Lavish Lashes® from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fees which might be asserted against them as a result of my having this procedure performed, or my purchase of these Lavish Lashes® products. As used in this Agreement, the terms “Professional” and “Lavish Lashes®” include all of their respective officers, directors, agents, employees, successors and assigns.
2. Permission to Use Pictures. I hereby grant to Professional and Lavish Lashes® the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by professional or Lavish Lashes®. I further expressly assign any copyright in these photographs to Lavish Lashes®. I also grant my consent for Professional and Lavish Lashes® to use my image and likeness as contained in these photographs for any advertising or other purposes, along with comments I may provide. Please use these images with the following:
my own nameno name to be useda fictitious name:
3. Care and Maintenance. I agree to follow the care and maintenance instructions provided by Lavish Lashes® and/or Professional for the use and care of my Lavish Lashes®, and that 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 Lavish Lashes® or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of my Lavish Lashes®. I will avoid getting my lashes wet within the first 24 hours after my application. For the first two days after application I understand it is best to avoid swimming, saunas or steam rooms. If I experience any itching or irritation, I agree to contact my Lavish Lashes® Professional immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my Lavish Lashes®. I agree to not pick, pull or rub my Lavish Lashes®. I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.
4. No Known Medical Conditions / Informed Consent. I have read and completed the Lavish Lashes® Client Intake Form in its entirety and in truth. I acknowlege that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelashes) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrolate or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2 hours or longer with my eyes shut, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the Professional’s or Lavish Lashes’® instructions or these warnings.
If any action is brought to enforce the terms of this Agreement, the prevailing party shall be entitiled to its costs and reasonable attorneys’ fees. Any claims arising out of this Agreement will be resolved though binding arbitration using the rules of the American Arbitration Association
This Agreement will remain in effect for this procedure, and all future procedures conducted by Professional or any other Professional conducting business at the establishment listed within this Agreement
I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am over 18 years of age and that I have the right to enter this Agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this Agreement, and his or her relationship to me is as follows: By his or her signature below, he or she ratifies and consents to this procedure under these terms.