Electronic Waiver For Eyelash Extensions

Eyelash Lift Waiver

I agree to have an eyelash lift and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash lift or eyelash tint by my technician.

I understand there are risks associated with having an eyelash lift 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 lifts 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 lifted as long as told.

I understand and consent to have my eyes closed and covered for the duration of the 45-60 minute procedure.

I am informing my technician of the following conditions below: * Please check it here.

Current use of contact lenses which I agree to remove during application
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 to instruments, fumes, tapes, cleaners, eye gel pads, adhesives, and removers that could cause my eyes to water and blink in excess
History of recurrent eye or tear duct infections
History of dry eyes or Sjogren's Syndrome
Other medical conditions which would prohibit or compromise the process and retention of this eyelash lift

I agree to the following eyelash perm post-op and maintenance instructions:

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

This agreement will remain in effect for this procedure and all future procedures conducted by my technician

I am over 18 years of age and consent to the agreement and to treatment.
I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for the length of time the lashes will stay lifted. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures.

By signing below, I verify that I have read and understood the above statements and agree to them.

First and Last name: * Please enter your name.

Your Signature *

Click to sign

Please sign here.

Electronic eyelash waiver is a versatile waiver production software applying to mobile phones, computers, and ipads.

Eyelash Lift Waiver