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Novalash Consent Forms

Privacy Policy

We value your privacy. We do not disclose any information you provide, and never share it with other entities outside of our Studio. Your information is used ONLY for internal statistic, marketing and informational purposes. We do not send bulk or spam email messages. We only communicate with our current clients that have an interest in becoming clients. We will, on occasion, send all of our clients group e-mail when special offers, price changes, or important issues arise.

 

EYELASH EXTENTION CONSENT FOR PROCEDURE

  1. I agree to only use recommended products on my Eyelash Extensions.
  2. I understand that there are many variables, including technician expertise, hair growth cycle, use of cosmetics and skin care products, and the overall care given, that will influence how long my Eyelash Extensions remain in place.
  3. I acknowledge that I should not rub my eyes or pull on my lashes after Eyelash Extensions have been applied.
  4. I understand that if a certified eyelash extensionist does not apply eyelash extensions properly, there is risk of eye damage and harm to my vision.
  5. I have been advised that using mascara on a regular basis can shorten the length of time my extensions remain in place. I have also been advised not to use waterproof mascara on my eyelash extensions.
  6. I understand that touch-up appointments will be necessary a few weeks after the application, and that there may be additional fees for this procedure.
  7. I have read and discussed the above information with my Certified Eyelash Extensionist.

I authorize Lash Cult Studio to apply the Eyelash ExtensionsTM product to my own eyelashes.

 

General Health and Safety Recommendations

eyelash extensionsTM are not for everyone; prior to application you should notify and discuss with your certified Eyelash ExtensionistTM if you have recently or frequently experienced any of the following:

  • Unusual sensitivity or skin reaction to Cyanoacrylate-based adhesives.
  • Moderate to severe allergies in combination with abnormal eye discharge.
  • Any eye disease or medical condition, such as Conjunctivitis (“pink eye”).
  • A compromised immune system due to cancer treatment, hepatitis, or advanced AIDS.
  • Any type of cancer
  • Alopecia
  • Skin disease
  • Any metabolic or endocrine disorder
  • Blunt trauma in or around the eye area.
  • Intoxication or impaired motor skills due to medications, alcohol, or any other drug.

​Never allow uncured cyanoacrylate-based adhesives or removers to contact the eyelid or eyeball. Any uncured cyanoacrylate-based adhesive or remover in contact with the eyelid or the eyeball may cause temporary or permanent eye damage, including temporary or permanent loss of or blurred vision. For any reason, if uncured cyanoacrylate adhesive or remover contacts the eye area, immediately flush with large amounts of water and seek immediate medical attention. Additional information may be found in the Material Safety Data Sheet (MSDS).

Tips for Maintenance and Care

To maximize the length of time eyelash extensionsTM remain in place, recommends the following:

  • Only a Certified Eyelash Extensionist should apply eyelash extensionsTM.
  • Use only recommended cosmetic products and cleansers (see aftercare instruction) once the extensions are applied.
  • Do not rub your eyes or pull on the lashes after eyelash extensions have been applied.
  • Avoid using mascara on a regular basis, as it can shorten the length of time the extensions remain in place.
  • Do not use waterproof mascara on your eyelash extensionsTM.
  • After the application, touch-up appointments will be necessary after a few weeks.

Consent for procedure

  1. I understand that eyelash extensionsTM are semi-permanent. I understand that the lasting beauty and effect are highly variable and are dependent upon, among other things the skill and expertise of the Certified Eyelash ExtensionistTM, my normal hair growth cycle, my use of cosmetics and skin care products, and my adherence to the instructions for maintenance and care.
  2. I have fully read and understood all of the information on this form. I have been given an opportunity to ask questions about the products, the application procedure, and any risks and hazards involved. I understand that any uncured cyanoacrylate-based adhesives or removers in contact with my eyelid or eyeball can cause temporary or permanent eye damage, including loss or blurred vision. My Certified Eyelash ExtensionistTM has fully explained the procedure and answered any questions to my satisfaction. I have sufficient information to give informed consent.
  3. I do not have any condition as noted above, or any other condition, which I am aware, that would affect the general use or application of eyelash extensions.
  4. I understand that touch-up appointments may be necessary for an additional fee.

I hereby consent to the procedure and authorize a Certified Eyelash ExtensionistTM, to apply the products to my own eyelashes.

 

Company Policy

Our time is very valuable to ensure that we can provide all of our clients the best look possible, for this reason, we please ask that you be on time to all of your appointments. Please try to arrive at least 5 to 10 minutes prior to your scheduled time to ensure you receive your full appointment time.

In the event that you should be tardy we please ask that you be considerate and call to inform us of your situation so we may take necessary action or make special arrangements. Please be aware that if you are 15 minutes or more overdue to your appointment you will need to reschedule your appointment, NO EXCEPTIONS.

In the event that you need to cancel or reschedule your appointment we ask that you please notify us within 24 BUSINESS HOURS before your appointment.

  • WE RESERVE THE RIGHT: to charge 50% of the scheduled service price when cancelling or rescheduling “the day of” your appointment.
  • WE RESERVE THE RIGHT: to charge 100% of the schedule services on NO-SHOWS.

**ALL CLIENTS MUST HAVE A CREDIT CARD ON FILE PRIOR TO BOOKING AN APPOINTMENT FOR ANY SERVICE TO
GUARATNTEE YOUR APPOINTMENT**

The satisfaction of our clients is our main priority. We offer prompt solutions to any problems or concerns that may occur.

Unfortunately, we do not offer refunds, credits or exchanges for products sold or services rendered.

If for any reason you feel dissatisfied with any of our services, please bring this to management’s attention. We
appreciated all feedback, negative or positive, from our clients to better serve you. As part of our service we like
to provide follow-up, by phone, for any questions or concerns.

Thank you for your business, in advance for choosing to have your services.

 

April 25, 2025

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
First Client's Signature*
Second Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Third Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Fourth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Fifth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Sixth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Seventh Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Eighth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Ninth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Tenth Client's Name

First Name*

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

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
Client's 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*
Check to receive information, news, and discounts by e-mail.
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Home Phone:

Alt Phone:

Work Phone:
Have you ever worn lash extensions before?*
No
Yes
Only Strip Lashes
Are you allergic to Medical Tape?*
No
Yes
Uncertain
Do you suffer from allergies?*
No
Yes
Do you have abnormally sensitive eyes?*
No
Yes
Had any eye surgery in the past month?*
No
Yes

How Did You Hear About Us?

Please check one of the following:*

Referred. By whom?


Name:
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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