Lash Lift & Tint Consent Form

Although it is impossible to list every potential risk and complication, the following conditions are recognized as contraindications for the Lash Lift and Tint treatment and must be disclosed prior to the treatment:

• Eye Infections/disorders

• Allergy to product

• Hay fever sufferers/Watery Eyes

• Stye

• Contact Lenses - must be removed

• Using prescribed medicated eye drops

• Medication - Thyroxin (in some cases can prevent lashes from curling)

• Recent Eye Surgery

• Very sensitive eyes

• Conjunctivitis

• Dry Eye Syndrome

• Pregnancy - during the 1st trimester

Although every precaution will be made to ensure your safety and well-being, before during and after your tinting application, please be aware of the possible risks below.

Please initial below each section.

I understand that lash lift and tinting has some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision and potentially blindness should any of the solutions enter into the

I understand that if the Lash Lift or Tinting solutions accidentally come in contact with my eye, my eye will be flushed with saline solution and medical attention may be required.

I understand that some irritation, itching or burning may occur to the skin which comes in contact with the lash lift or tinting solutions.

I understand that there may be some residual dark staining left on the skin follow the tinting process of either my lashes, brows or both. This will fade and go away within a short time.

I understand that, while every attempt will be made to provide me with my chosen color, everyones hair absorbs color differently and my final results may not be the color I initially wanted.

I understand that over the course of several weeks, the tint will gradually lighten and fade. Re-tinting will be required to keep the new color fresh. Most clients need to re-tint every 3-4 weeks.

I understand that over the course of several weeks my lashes will relax and return to their normal shape. Re-lifting will be required to maintain the curl and lift you desire. Most clients need to re-lift every 4-6 weeks.

I have read the above information. If I have any concerns I will address these with my skin care professional. I give my permission to my skin care professional to perform Lash Lifting, Lash Tinting or both procedures we have discussed, and will hold him/her and his/her staff harmless from any liability that may result from their treatment. I have accurately answered the questions above, including all known allergies,prescription drugs, or products I am currently ingesting or using topically. I understand my esthetician will take every precaution to minimize or eliminate negative reactions as much as possible.

In the event I may have additional question or concerns regarding my treatment, I will consult the esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraph 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 esthetician, whose signature appears below responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.