ALLERGY & INFORMED CONSENT

Before your appointment, please take a few minutes to complete this intake form. Your answers help us understand your lash history, preferences, and any sensitivities so we can customize a safe, comfortable, and beautiful lash experience just for you. All information is kept private and used only for your services and care.

NJ CLIENT SAFETY DISCLOSURE

All implements are properly cleaned and disinfected between clients. Only professional cosmetic-grade products are used.

This service is cosmetic and not medical. Service will be discontinued if irritation occurs.

ADHESIVE RISK ACKNOWLEDGMENT

Eyelash extension adhesive contains cyanoacrylate and may cause:

• Redness. • Itching. • Swelling. • Burning. • Watery eyes

Reactions may occur during or within 24–72 hours after application.

A patch test reduces but does not eliminate risk. Allergies can develop at any time.

CONSENT & RELEASE

MEDIA RELEASE (OPTIONAL)

SIGNATURE

I have read and agree to the terms above.