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Lash Medical
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Name
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Last
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Do you have any of the following conditions?
Allergies to adhesive tape, fumes or eye remover
Dry Eye Syndrome
Sjorgen's Syndrome
Currently having Chemotherapy
Ocular Rosacea
I consent to having my eyes closed and covered for the duration of the 45-60 minute procedure.
Yes
No
Do you wear contacts?
Yes
No
Please read the following
I agree to have an eyelash lift (perm) and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm or eyelash tint by my technician.
I understand there are risks associated with having an eyelash perm and/or eyelash tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense.
I understand that even though my technician perms the lashes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care.
I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told.
Post Lash lift, you agree to the following
No water can come in contact with the eye area for 24 hours after the application
Avoid using oil containing sunscreens, moisturizers and cleansers of on lashes
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