Informed Consent: Lash Extensions – Consent Forms- Med Spa at Villagio

Although every precaution will be taken to ensure your safety and wellbeing before, during, and after your lash extension application, please be aware of the following information and possible risks. Please initial:

I understand that a full set of lash extensions can make the appearance of my own lashes about 30-40% thicker, and make my lashes appear 20-50% longer.

I understand that the lash extension services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision and potential blindness should the adhesive enter the eye or should an allergic reaction occur.

I understand that some irritation, burning or itching may occur in the skin if the bonding agent comes into contact with it.

I understand that if the bonding agents comes into contact with my eye, my eye will be flushed with water and I will be assisted in seeking medical attention immediately.

I understand that this a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch-up or “fill” appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks.

I understand that while every attempt will be made to provide me with the length and fullness I have chosen, my final result may not be what I initially envisioned.

I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.

I understand that additional circumstances may occur or be discovered during the procedure which could affect my ability to tolerate the procedure.

I consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.

I understand that if I have any concerns, I will address these with my lash extension specialist. I give permission to my lash extension specialist to perform the lash extension procedure we have discussed, and will hold them her/him or the staff members harmless and nameless from any liability that made result from this treatment. I do not hold the lash extension specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of the procedure, which may be affected by the treatment performed today. I certify that I have read and I fully understand the above paragraphs and I understand the procedure and accept the risks.

Lash extension specialist

Client Signature

Date