Loading...

I authorize TREAT esthetician to perform the Lash Lift or Lamination procedure. I understand the Lash Lift and Lamination procedure is as follows:

 

Brow Lamination process is similar to the lash lift just on the brow area. same products will be used. 

Lashes or brows are cleaned
Bottom lashes may be covered with tape
A silicon Pad is glued to the eyelid with a water soluble glue
Lashes are lifted on the pad with glue
The following solutions are applied to the lashes that are lifted on the pad (one at a time for a minimum of 10 minutes and a maximum of 20 minutes): Perm Lotion and Setting Lotion
Lashes are cleaned
Optional Lash Tint is applied

 


I understand that it is my responsibility to be still during the procedure and to keep my eyes closed during the process unless otherwise advised. Eyes and the skin around them are extremely delicate, and can incur damage, including irritation, burning and allergic reaction to the products used to lift the lashes and/ or the tape, anti-wrinkle gel patches or black eyelash tint. These reactions can include anything from mild irritation to a full-blown allergic reaction, even blindness. I have been fully informed as to the methods and procedures concerning the Lash Lift procedure and the risks of the cosmetic procedure I have chosen have been disclosed to me.

 

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
Recent Eye Surgery
Allergy to product
Very sensitive eyes
Hay fever sufferers/Watery Eyes
Conjunctivitis
Stye
Dry Eye Syndrome
Using prescribed medicated eye drops
Pregnancy - during the 1st trimester
Medication - Thyroxin (in some cases can prevent lashes from curling)
Contact Lenses - must be removed

 

If at any time I (or the technician) are uncomfortable with the Lash Lift or Lamination procedure, I will inform the technician and he/she will gladly rectify the problem, including ending the session if I (or the technician) wishes. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this treatment have been made. I acknowledge that I have no particular representation or guarantees and I am consenting to the procedure at my own risk. All conditions must be revealed or disclosed by me to the technician regarding my health history, medications being taken and any past reactions to products used or medications taken. Additional conditions could be discovered during the procedure, which could affect my ability to tolerate the procedure.


 

 

 

First Please select who will be participating... Name

First Name*

Middle Name

Last Name*

Phone*
First Please select who will be participating... Date of Birth*
First Please select who will be participating... Signature*
Second Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Second Please select who will be participating... Date of Birth*
Third Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Third Please select who will be participating... Date of Birth*
Fourth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Fourth Please select who will be participating... Date of Birth*
Fifth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Fifth Please select who will be participating... Date of Birth*
Sixth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Sixth Please select who will be participating... Date of Birth*
Seventh Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Seventh Please select who will be participating... Date of Birth*
Eighth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Eighth Please select who will be participating... Date of Birth*
Ninth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Ninth Please select who will be participating... Date of Birth*
Tenth Please select who will be participating... Name

First Name*

Middle Name

Last Name*
Tenth Please select who will be participating... Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!