Personal agreements. I agree that I have read the FAQ on mindfulpractice.co as instructed before coming in for my appointment. I agree that I am at least 18 years of age. I agree that I have not had Lasik eye surgery, eye illness or injury in the last 6 months, and I do not have seasonal allergies. I agree that I have not had permanent eye make up in the last 6 months. I agree that I do not have allergies to adhesives found in bandaids or medical tape. I do not have allergies to medical grade adhesive and I have had or I am waving my right to a free allergy test patch. I have not used Retinoids used to treat ache and skin problems such as Accutane and Rein A. I do not have hormonal imbalances or extreme stress. I will let my technician know if I am pregnant, have had a recent severe illness or major injury. I have not recently been prescribed a new prescription. I do not have any medical conditions that are related to hair or eyelash loss. I do not have any vitamin A, B, Selenium, Zinc, Iron, or Folic Acid deficiencies (These aid hair loss). I do not have Trichotillomania (hair pulling disorder). I do not take medications that may contribute to hair loss; Chemotherapeutic agents in cancer treatment, blood thinners, or Beta blockers (used to control blood pressure). I have agreed to have eyelash extensions or a lash lift applied and/or removed from my eyelashes. Before my qualified professional can perform this procedure, I understand I must complete this Agreement and provide my informed consent by signing and dating where indicated below. By singing this form I have agreed to either have an allergy test patch done or I am waving my right to a free allergy test patch. For valuable consideration, in order to have eyelash extensions applied and/or removed from my eyelashes: Waiver of Liability. I understand there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes as well as risks associated with any lash lifting and tinting process. I understand that notwithstanding the utmost care in the application or removal of these products, there still exists risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and in rare cases, blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial lashes to my existing eyelashes or curl my existing lashes. Even though the Professional may apply or remove my extensions properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes. I also understand there is more than one technique for applying eyelash extensions or a lift to my eyelashes, and I will not attribute any liability to the Professional as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless the Professional from any and all claims, actions, expenses, damages, and liabilities, including reasonable attorney’s fees which might be asserted against them as a result of my having this procedure performed, or my purchase of the products sold. As used in this Agreement, the terms “Professional” include all of their respective officers, directors, agents, employees, successors, and assigns.
Permission to use pictures. I hereby grant to the Professional the full right to take, publish, and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by the Professional. I further expressly assign any copyright in these photographs to Mindful Practice. I also grant my consent for the Professional to use my image and likeness as contained in these photographs for any advertising or other purposes, along with comments I may provide.
Care and Maintenance. I agree to follow the care and maintenance instructions provided by my Professional for the use and care of my lash extensions, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my lash extensions or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of my lashes, I will avoid getting my lashes wet within the first 14 hours after my application. For the first two days after application I understand it is best to avoid swimming, saunas, or steam rooms. If I experience any itching or irritation, I agree to contact my Professional immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my lash extensions. I agree to not pick, pull, or rub my lash extensions. I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.
No known medical conditions/informed consent. I have read and completed the client intake form in its entirety and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelashes) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye, and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate, or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up to two hours or longer with my eyes shut, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the Professional’s instructions or these warnings.
Corona Virus Liability Release.
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. It is believed that an asymptomatic individual can be infected with and transmit COVID-19 without their knowledge. Due to the global pandemic outbreak of COVID-19 and for the safety and protection of the health of our practitioners and clients we are implementing additional safety measures in compliance with the safety precautions published by the Center for Disease Control, State of Minnesota, and MN Board of Cosmetology. Symptoms of COVID-19 Include: Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea I agree to the following: I understand the above symptoms and affirm that I, as well as all household
members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. I affirm that I, as well as all household members, have not traveled outside of the country or to any city or state considered to be a “hot spot” for COVID-19 infections within the past 30-days. I understand that Mindful Practice and Lovdahl Salon and Studio LLC and cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client. I understand that Mindful Practice and Lovdahl Salon and Studio LLC and are taking extra precautions in order to preserve the health of the practitioners and their clients. I agree to cancel or reschedule my appointment if I, as well as any household members, are currently exeriencing or have experienced ANY COVID-19 symptoms listed above within the past 14 days. I agree to cancel or reschedule my appointment if I, as well as any household member, has been diagnosed with COVID-19 within the past 30 days. I agree to cancel or reschedule my appointment if I, as well as any household member, is currently pending COVID-19 test results.
By signing below, I agree to each statement above and release Mindful Practice, Lovdahl Salon and Studio LLC as well as their practitioners and staff, from any and all liability for exposure or harm due to COVID-19 or any other contagion.
I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form. Additionally, By signing below, I confirm that I have reviewed, understood, and signed this form on the same day of my scheduled appointment at Mindful Practice. If any actions is brought to enforce the terms of this Agreement, the prevailing party shall be entitled to its costs and reasonable attorneys’ fees. Any claims arising out of this Agreement will be resolved through blinding arbitration using the rules of the American Arbitration Association. This Agreement will remain in effect for this procedure, and all future procedures conducted by the Professional or any other Professional conducting business at the establishment listed within this Agreement. I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am over 18 years of age and that I have the right to enter this Agreement.
Your Establishment’s Name: Mindful Practice/Lovdahl Salon and Studio Certified Lash Specialist’s Name: Andi Hanson | 