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Bare Envy Eyelashes
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New Client Consent Form
Bare Envy Eyelashes
Home
Blog
Services
The Lift Bar
Lash Extensions
Photos
Eyelash Guideline
BOOK NOW!
Contact
Testimonials
New Client Consent Form
New Client Consent Form
Eyelash Extensions & Eyelash Lift & Tint Services
Bare Envy Registration
Full Name
*
Email
*
Phone
*
How did you hear about us?
*
Google
Social Media
Other
Referred By
Please check all that apply to you:
Laser Eye Surgery
Regular exposure to chemicals
Alopecia (hair loss)
Seasonal Allergies
Allergies to synthetics
Eating disorders (causing hair loss)
Allergies to adhesives
Recently treated for eye injury
Dry eyes
Diabetic
Microdermabrasion
Chemotherapy
Sty or Cyst
Blepharitis
Conjunctivitis
Lifestyle Information:
Are you currently wearing eyelash extensions?
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Yes
No
Have you had a lash perm/tint in past 6 weeks?
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Yes
No
Are you pregnant or breastfeeding?
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Yes
No
Have you been treated in hospital over past 6 months?
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Yes
No
Do you wear strip lashes?
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Yes
No
Do you use an eyelash curler/heater?
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Yes
No
Do you use mascara?
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Yes
No
Do you use eye cream/gel?
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Yes
No
Are you wearing contact lenses now?
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Yes
No
What look would you like to achieve with your application today?
Why do you want this treatment?
Daily wear
Special occasion
Other
Would you like more information on any of the other services that we provide?
Lash after care products
Referral Program
New Client Consent Form
Please initial at each line and sign at the bottom.
I understand that there are risks associated with having artificial eyelashes applied to and/or removed from my natural lashes. (Initial)
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I understand that as part of the procedure, eye irritation, pain, itching discomfort and in rare cases eye infection may occur. (Initial)
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I understand that even though the technician may apply and remove the eyelash extensions properly, that adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow up care. (Initial)
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This agreement will remain in effect for this procedure and all future procedures conducted by my technician or any other technician conducting business at the salon/spa listed below. I understand that this agreement is binding and that I have read and fully understand all information above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form. (Initial)
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I give consent for photographs to be taken of my lashes and used for the salon’s use. (Initial)
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I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the client's natural eyelashes. (Initial)
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I understand and agree that if I experience any of these issues with my lashes I will contact my technician and have the eyelash extensions removed immediately and consult a physician at my own expense. (Initial)
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I understand and agree to follow the aftercare instructions provided by my technician. Failure to follow the aftercare instructions may cause the eyelash extensions to fall out. I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for duration of 60- 180 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes. (Initial)
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I release my technician and/or Bare Envy, from all liability associated with this procedure. There are no guarantees for the bonding time length of the eyelash extensions. Our company or salon is not responsible for any technician errors. I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed (Initial)
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By booking this appointment, you agree to a cancellation fee of 50% of the service value should you cancel less than 24 hours from the time of your appointment. You will be charged 100% of the service for a NO-SHOW or a cancellation less than 1 hour from the time of your appointment. Exceptions may apply for COVID-19 prevention.
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By signing below, I verify that I have read and understand the above statements and agree to them.
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Date / Time
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Phone
Submit