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Client Information

Client Information

Eyelash Extension History

Please answer the following questions. 1 OF 12 QUESTIONS

Is this your first time getting eyelash extensions?

Eyelash Extension History

Please answer the following questions. 2 OF 12 QUESTIONS

Have you ever had eyelash extensions removed?

Eyelash Extension History

Please answer the following questions. 3 OF 12 QUESTIONS

Do you have a tendency to rub your eyes or pull your eyelash?

Eyelash Extension History

Please answer the following questions. 4 OF 12 QUESTIONS

Do you wear contact lenses?

Eyelash Extension History

Please answer the following questions. 5 OF 12 QUESTIONS

Do you wear eye glasses?

Eyelash Extension History

Please answer the following questions. 6 OF 12 QUESTIONS

Have you had permanent cosmetics applied to your eyes?

Eyelash Extension History

Please answer the following questions. 7 OF 12 QUESTIONS

Do you go tanning or get spray tans?

Eyelash Extension History

Please answer the following questions. 8 OF 12 QUESTIONS

Are you currently using or previously used prescription-strength Retin-A, Accutane or similar products?

Eyelash Extension History

Please answer the following questions. 9 OF 12 QUESTIONS

Do you have history of eye disese, conditions, injury, or surgery that affected your hair/natural eyelash growth or loss?

Eyelash Extension History

Please answer the following questions. 10 OF 12 QUESTIONS

Have you undergone recent eye surgery and had wounds or infections?

Eyelash Extension History

Please answer the following questions. 11 OF 12 QUESTIONS

Are you pregnant?

Eyelash Extension History

Please answer the following questions. 12 OF 12 QUESTIONS

Have you ever received eyelash extensions that you were unhappy with?

Eyelash Extension History

Please answer the following questions.

* PLEASE DESCRIBE WHAT WAS WRONG WITH THEM?

Others:

Eyelash Extension History

Please answer the following questions.

WHICH SIDE DO YOU SLEEP ON?

Others:

Health History

DO YOU HAVE ANY KNOWN ALLERGIES?

PLEASE CHECK ANY THAT APPLY:

ANY SPECIAL CONDITIONS WE SHOULD KNOW ABOUT?

Referral

HOW DID YOU HEAR ABOUT US?

Others:

WHICH ONE OF OUR LOVELY CLIENTS REFERRED OUR LASH BAR TO YOU?

Waiver

I understand that this procedure requires single synthetic eyelashes to be adhered to my own natural eyelashes. I understand that what I want may not be indentical to pictures I have seen, as the amount of lashes I have will be the guide to what length, curl and thickness I can receive. I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, since tweezers and glue are by our eyes. I understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause to tear up if I open my eyes. I agree to disclose any allergies I have to surgical tapes, cyanoacrulate, creams, etc. I agree that by reading and signing this consent form, I release Flux Lash Bar from any claims or damages of any nature. I understand that any allergic reaction is possible from the adhesive cause redness along the eye line and swollen eyes. An allergic reaction could happen immediately, a few months, or years later or not at all, however; I am fully aware that this is a possibility. I understand that I requested for the service and a trained professional will perform the service to its highest standard. If a reaction does occur, I agree to contact Flux Lash Bar to have them removed at no charge and I also understand that a refund will not be provided.

Waiver

I (hereinafter the "client") authorize Flux Lash Bar at (18 Fred Varley Dr. Unit 1, Unionville, ON) a trained and certified lash extension professional, to perform the application of eyelashes extensions. A thorough explanation of the procedure, processes, and any procedural complications will be discusses with me. I will also be provided with aftercare instructions and I will adhere to those instructions.

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