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Eyelash Extension
Client Intake Form

Client Information:

Medical History:

Do you have or have you had any of the following conditions? If yes, please select them:

Are you allergic to acrylic or latex?

(Medical tape and adhesives required for eyelash extensions may contain acrylic or latex.)

EYELASH HISTORY:

Eyelash Extension
Client Consent Form

I hereby consent to and authorize Anabelle Nail Cafe Technician to perform the following procedure eyelash extension services . Although every precaution will be taken to ensure your safety and wellbeing before, during and after your lash extension application, please be aware of the following information and possible risks.
Please initial each statement:

Current use of contact lenses which I may be asked to remove during the procedure.

Current use of anything such as oil-containing sunscreen or moisturizers around the eyes.

Current use of eye drops of any kind, prescription or over-the-counter.

Current allergies or sensitivities.

History of recurrent eye or tear duct infections.

History of dry eyes or Sjorgen’s Syndrome.

Recent history of Chemotherapy.

Other medical conditions which would prohibit or compromise placement and retention of eyelash extensions.

No waterproof mascara.

No oil based products around the eye area.

No water can come in contact with the eye area for 24-48 hours after the application.

No tinting or perming of eyelash extensions.

No pulling or rubbing of the eyelash extensions.

Should any kind of eye drops be necessary extra care should be taken to prevent moisture from coming into contact with the eyelash extensions.

This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extension professional. I understand my lash extension specialist will take every precaution to minimize or eliminate negative reactions as much as possible. I will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the lash extension specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.