Loading...

Procedure, policy and consent for treatment

Luxi Lush

Consent for treatment for eyelash extensions

 

Procedure:

The application of eyelash extensions can take anywhere from 1 to 2 1/2 hours. You will have your lower eyelashes held down with under eye gel pads that are made for eyelash extensions.  This is done so the lower and upper lashes do not get bonded together when your eyes are closed.  The adhesive I use is very strong and can have a fume to it that can irritate your eyes. Please do not chew gum, talk with facial expressions, laugh or open your eyes during the procedure.  For persons with severe allergies or any conditions that induces watery eyes, please be aware that this can cause your extensions to fall out prematurely due to them getting wet too soon.

Aftercare:

There are many factors that can affect the wear of your lash extensions, there are no guarantees on how long your extensions will last. Following aftercare instructions will help your extensions last longer and look their best. If you have any itching or swelling of the eye area, please contact me immediately.  There are a small number of people who may have a reaction to the adhesive.  If you contact me right away, we may be able to save your extensions.  In rare cases, the extensions will need to be removed.  If you have any questions, please do not hesitate to call/text.  Any issues should be reported within 24 hours.

 

Appointments/Cancelation Policy:

Please be on time for your appointments.  If you are more than 10 minutes late you may be asked to reschedule or I may not have the necessary time for a proper application (at the 15 minute mark, the appointment could be marked as a “no-show”).  If you need to cancel or reschedule your appointment, please do so at least 24 hours in advance so that I may accommodate another client.  The penalty for a late cancel (less than 24 hours prior to the appointment start time) or no-show appointment is 50% of the scheduled service(s).  All clients are required to keep a valid credit/debit card on file and complete a credit card authorization form.  There are no refunds.

By signing below, I attest that I am of at least 18 years of age, understand the above procedure, appointment/cancelation policy, have read all information and all questions have been answered.  I do not hold Kym Glover/Luxi Lush responsible for any damage to my eyelashes or eyes from having eyelash extensions on or from the procedure itself.

 

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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.
Parent or Guardian's Name

First 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!