top of page

Consent Form for Eyelash Extension

Personal Details

Check-in location
Redmond
Seattle
HOW DID YOU HEAR ABOUT US?

Consent Acknowledgement

ALL SERVICES ARE PROVIDED BY INDEPENDENT CONTRACTORS---A+ ILASH STUDIO


Disclaims any and all express or implied representations and warranties with representations and warranties with respect to the services provided by it, independent contractors. A+ ilash studio is NOT LIABLE for any indirect, incidental, special exemplary, punitive or consequential damages incurred by any party, whether in contract, tort, or based upon a warranty, even if the party has been advised of the possibility of such damages.

Is this the first time you have lash extensions applied?
Yes
No
Do you habitually rub, pull, or pick your lashes for any reason?
Yes
No
Are you allergic to latex or acrylic? (Eyelash extensions require medical tape and adhesives that may contain acrylic or latex.)
Yes
No
Do you have, or are you being treated for any eye illness or injury?
Yes
No
Are you able to keep your eyes closed and lie still for up to 2 hours or longer?
Yes
No
Please indicate if you have worn within the last 60 days any of the following types of lashes:
Do you _______ your lashes?
Are you have lash extensions applied for:
Do you wear contacts?
Yes
No
Do you wear glasses?
Yes
No
Please check off any of the following that might apply to you:

Permission to Use Pictures:

I grant A+ Ilash Studio, LLC, and the technician permission to take, publish, and reproduce photos of my face, eyes, and/or eyelashes before and after the procedure for advertising, educational, or other purposes. I also assign
Yes
No

I agree to have eyelash extensions applied and/or removed from my natural eyelashes. Before my technician performs the procedure, I understand that I must complete this agreement and provide my informed consent by signing and dating below.


1. Waiver of Liability:

I understand there are risks involved in applying and/or removing artificial eyelashes. Despite the utmost care taken during the procedure, potential risks include eye irritation, discomfort, and, in rare cases, blindness if handled improperly. During the procedure, adhesive will be used to attach the extensions, and while the technician will follow best practices, the adhesive may become dislodged, causing irritation or requiring additional medical care at my expense. I acknowledge there are multiple techniques for eyelash application, and I will not hold the technician or A+ Ilash Studio, LLC liable for any issues related to the procedure or the products used. I agree to defend, indemnify, and hold harmless the technician and A+ Ilash Studio, LLC, against any claims, damages, or liabilities, including attorney's fees, that may arise from this procedure or my purchase of products. This includes their officers, directors, agents, employees, and assigns.


2. Care and Maintenance:

I agree to follow the care instructions provided by A+ Ilash Studio, LLC and/or the technician. If any follow-up care is needed due to my negligence or failure to follow instructions, I will bear the cost. To achieve the best results, I agree to:

Avoid oil-based eye products, which can weaken the adhesive.

Keep my lashes dry for the first 24 hours after application.

Refrain from swimming, saunas, or steam rooms for the first 48 hours.

Contact my technician immediately if I experience any itching or irritation to have the extensions removed.

Avoid using waterproof mascara, eyelash curlers, perming, or tinting the extensions.

Not pick, pull, or rub my extensions.

Have lash extensions professionally removed and not attempt to do so on my own.


3. No Known Medical Conditions / Informed Consent:


I have completed the A+ Ilash Studio Client Intake Form and understand that the procedure may pose risks to those with certain medical or skin conditions. I am aware that the adhesives and removers may cause irritation and that allergic reactions to synthetic materials, cyanoacrylate, or formaldehyde, though rare, may occur. I understand that I must remain still for up to two hours with my eyes closed during the procedure and will remove my contact lenses if necessary. I confirm that I have no medical conditions that would be aggravated by this procedure or prevent me from adhering to the instructions provided by the technician or A+ Ilash Studio, LLC.


4. Third-Party Discount Coupons:

Not valid for customers who have used services at any A+ Ilash Studio location in the past 12 months. A+ Ilash Studio reserves the right to make final interpretations regarding these coupons.


Additional Terms:

If any action is taken to enforce this agreement, the prevailing party will be entitled to recover costs and attorney's fees. Any disputes arising from this agreement will be resolved through binding arbitration under the American Arbitration Association's rules.

This agreement remains in effect for all future procedures performed by the technician or any other professional at A+ Ilash Studio.

By signing below, I confirm that I am over 18 years of age, or if under 18, I have obtained consent from my parent or legal guardian. The signature below ratifies and consents to the procedure under these terms.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
bottom of page