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I consent to have synthetic eyelash extensions attached to my natural eyelashes at Hell On Heels Beauty by Angelica Deering. The Service and its associated risks have been explained to me by the Service Provider in terms that I understand. The information was obtained from the Service provider's Website and from the ability for myself, the Client or the Guardian to ask the Service Provider for more information. The explanation included: The benefits of the Service; The nature of the Service and how the Service will be performed; and The types of materials and adhesives used during the Service. How to properly care for the synthetic eyelashes applied during the Service; and Factors that affect retention of eyelashes as well as care for all other services performed at "Hell On Heels Beauty".

I Agree
 

The most frequently occurring risks of the Service, and those risks which are unlikely to occur but which may involve serious consequences, include but are not limited to the risk of experiencing: (a) Blepharitis and its associated symptoms, (b) an allergic reactions to the adhesive material used to attach the eyelash extensions to my natural eyelashes and to the synthetic eyelash material, (c) Traction Alopecia and its associated symptoms; (d) an eye injury due to synthetic and/or natural eyelashes falling on or into the eye; and (e) an eye or other injury occurring during the performance of the Service.

I Agree
 

I consent to brow/lash perming and tinting (Now or in the future if I choose to) at Hell On Heels Beauty by Angelica Deering or another employee. The Service and its associated risks have been explained to me by the Service Provider in terms that I understand. The information was obtained from the Service provider's Website and from the ability for myself, the Client or the Guardian to ask the Service Provider for more information. I understand the risks associated with these services and in some cases, they may include: blisters, rash, redness, dry eye, watery eyes, inflammation, and more brittle lash hair. Refectocil tints also pose a rare or extreme side effect of vision change if the solution comes into contact with the eye. I understand that if I have any of the following conditions: eye allergies, eye infections, skin sensitivity, styes, chronic dry eye, and/or watery eyes, lash perming(Lash lifts) and lash tinting are NOT recommended. Lash perming/tinting(Lash lift) is NOT available for those who have had Lasik (laser corrective eye surgery) done within the last 6-12 months

I Agree
 

I consent to facial hair removal on my face (Now or in the future if I choose to) at Hell On Heels Beauty by Angelica Deering or another employee. The Service and its associated risks have been explained to me by the Service Provider in terms that I understand. The information was obtained from the Service provider's Website and from the ability for myself, the Client or the Guardian to ask the Service Provider for more information. I understand the risks associated with these services and in some cases, they may include: Pain (With any type of waxing, a small amount of pain is inevitable.)Redness and irritation. Facial waxing can also cause mild redness and irritation temporarily after use, Rashes, Temporary bumps, Ingrown hairs, Sun sensitivity, Allergic reactions, and Bleeding. I understand that I must follow the pre-procedure and post-procedure steps set by the Service Provider.

I Agree
 

I was given the opportunity to ask the Service Provider any questions I have regarding the Service(s) and I have had those questions answered to my satisfaction. I understand I can ask questions in the future too should any arise. Based on the foregoing, I hereby assume all of the risks associated with the Service(s), whether known or unknown, including, but not limited to, the risk of personal injury or property damage. As consideration for Angelica Deering and all employees performing the Service, I forever release Hell On Heels Beauty and his/her/its respective directors, officers, members, managers, employees, agents, contractors, attorneys, representatives, successors and assigns from any and all actions, claims, or demands that I, my assignees, heirs, next of kin, spouse, personal representatives and legal representatives now have, or may have in the future, for injury, death, or property damage, in any way related to the Service.

I Agree
 

By initialling at the end of this paragraph, I grant the Service Provider permission to reproduce, publish, distribute or otherwise use in any reasonable manner my name, photograph, likeness and statements, including, but not limited to, before and after pictures of my eyes and eyelashes, and face in connection with the promotion of the Service(s) or the products used in the Service (or other similar services and products) in all media, including without limitation, the internet, news articles, advertisements, or other electronic or printed materials. If my initials are not present at the end of this paragraph, then the above-described permission has not been granted.


Artist Guarantee:

I do not offer refunds on services. I do however offer a 48-hour guarantee on all my services. If you have an adverse reaction to the lashes and are unable to wear the eyelash extensions that were applied, I will remove them free of charge.I appreciate reviews and willingly accept feedback from clients. You agree first to contact me and attempt to resolve issues privately and not to post negative feedback towards my business Hell On Heels Beauty and the Owner, Angelica Deering. I offer complimentary fixes for lash extensions/lash lifts within 48 hours as long as the Client has followed pre-procedure and post-procedure steps. In the event that the lashes need to be fixed due to the fault of the Client, I do offer a discount. (Sometimes a client may use a product that is not face/lashes suitable for the lashes causing adverse effects to the lash extensions or lash lift/Brow lamination) By checking the box, you agree to contact me in the event you are unsatisfied.

I Agree


Allergies: If you experience an allergic reaction to any of the products used during the service, please contact me immediately for assistance in assessing the situation. I will advise you to seek medical attention as I am not a doctor. If you have not had any of the following: lash extension adhesive applied to your lashes prior, brow/lash perming solutions, brow/lash tints, and or waxing compounds, it is imperative that you have a patch test done and by initialling this you admit to having done so with no adverse effects.

I Agree
 

Cancellations/Missed Appointments/ Late Arrival: I require 48 hours notice for Appointments that require cancelling/rescheduling. If you are cancelling last minute (For Any Reason) there is a $25 charge that will be required to be paid before you may book again. you will be required to book with a credit card for future appointments and a 50% deposit will need to be paid by said credit All appointments will be rescheduled if you are late more than 10 mins. Unless you call and receive approval directly from Angelica at Hell On Heels Beauty. By initialing you understand and agree.

I Agree
 

I understand that if I am under the influence of drugs and/or alcohol, I cannot have any services performed at Hell On Heels Beauty and will need to reschedule.

I Agree
 

Link To Website where the Pre-Procedure and Post-Procedure Information can be found.

https://www.hellonheelsbeauty.org

First Client Name

First Name*

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First Client Signature*
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Ninth Client Age
Tenth Client Name

First Name*

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Tenth Client Date of Birth*
Tenth Client Age
Client Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Have you ever had Lash Extensions?
Yes
No (If selected, please be sure to text me to discuss whether an allergy test for extensions is needed. This is YOUR responsibility and failure to do so could result in a cancelled appointment.)
Have you ever had a Lash Lift?
Yes
No (If selected, please be sure to text me to discuss whether an allergy test for extensions is needed. This is YOUR responsibility and failure to do so could result in a cancelled appointment.)
Check all that may apply
Permanent eye/brow makeup less than 3 months ago
Eye infections in the past 3 months such as a stye or Blepharitis/ seborrheic dermatitis
Cold Sores on the face either now or in the past
Chemotherapy in the last 12 months
Pregnancy
Topical Retinoids(Sometimes referred to as topical accutane), Any type of peeling agent such as Glycolic Acid, Salicylic Acid, Lactic Acid, Trichloroacetic Acid. (It's vital you disclose this so that I can limit my hand contact with your face so as to not have my skin absorb the products because of adverse affects to myself)
NONE APPLY
Mental Illness ( I ask this because if you suffer from anxiety, sensory processing disorder, etc. etc. I want to make sure that I can create a safe and calm environment for you to have a relaxing time without stress.)
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Age
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.


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