Eyelash


 

 

 

Lavender-Falls-Stone-Oak-Spa-San-Antonio

Lavender Falls Face & Body Spa LLC

Client Informed Consent Form

Eyelash Extensions

 

PLEASE READ CAREFULLY & COMPLETELY

 

19239 Stone Oak Pkwy, Suite #201

San Antonio, Texas 78258

Phone: 210-446-0903

www.sanantonio.lavenderskinspa.com

Online Booking Available

Treatment Consists of:

Eyelash extensions are individual Synthetic, Mink and/or Silk eyelashes. They are attached one-by-one to each of your individual natural lashes – not to the skin. This service is beauty enhancing and eliminates the need to wear mascara. It is a meticulous service which requires the skill and precision of your Certified Lash Technician. Once the eyelash extensions are applied, they are natural looking.

Length, width, and style of lash will be decided and agreed upon with your Certified Eyelash Technician.

As your natural lashes grow and fall out due to the natural growth cycle, you will need refills. It is important to have 75% of the extensions on your lashes in order to maintain the desired clean, full consistent look. Recommended fills are every 2 - 3 weeks.

Clients Acknowledgements:

Contraindications include any active eye infection caused by a bacteria or virus. Symptoms include eye redness, discharge and/or swollen lids. Pink eye (conjunctivitis), styes and hay fever. Dry eye syndrome; Body and head lice should be avoided at all times while doing eyelash extensions. Topical or oral retinoids or use of steroids.

Anxiety, some clients feel trapped when the gel pads are placed.

Pregnancy- Some women cannot handle the adhesive fumes while pregnant. Their eyes may burn and water.

Information: I acknowledge that I have read and have notified my Aesthetician of the following:

Pre-Treatment Acknowledgement

       Current use of eye drops of any kind, prescription or over-the-counter.

 

       Current use of anything such as oil-containing sunscreen or moisturizers around the eyes

       Current allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives, and removers that could cause my eyes to water and blink in excess

       History of claustrophobia.

       History of recurrent eye or tear duct infections

       History of dry eyes or Sjorgen’s Syndrome

       Recent history of other medical conditions which would prohibit or compromise placement and retention of eyelash extensions

*Notify your aesthetician of any medical conditions & medications (Current & within the last 90 days).

Post Treatment Acknowledgement

       Avoid hot steam on lashes for 24 hours.

 

       Wipe NovaLash clean lash pads on lashes to remove oils & debris once every 4 days.

 

       Comb lashes after shower to keep free of tangles.

 

       No waterproof mascara.

 

       No prescription or over-the-counter eye drops.

 

       No oil based products around the eye area.

 

       No tinting or perming of eyelash extensions.

 

       No eyelash curlers.

 

       No continuous pulling or rubbing of the lashes.

 

 

 

 

Side Effects:

Possible side effects include but are not limited to:

       I understand there are risks associated with having artificial eyelashes and eyelash extensions applied to, or removed from my natural eyelashes.

       I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases,

Eye infection or blindness can occur.

       I agree that if I experience any of these medical conditions with my lashes I will contact the certified eyelash extension professional and have the eyelashes removed immediately and consult a physician at my own expense.

       I understand that even though the certified eyelash extension professional applies or removes the eyelash extensions using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care and subsequent removal of the eyelash extensions.

Risks:

There are risks associated with having artificial eyelashes and eyelash
extensions applied to, or removed Extensions attached to my natural
eyelashes, the following can occur but are not limited to:

• Itching
• Swelling of eyes and lids
• Slight scabbing of lids
• Watering of Eyes
• Irritation and redness
• Inflammation
• Infections
• Allergic Reactions
• Conjunctivitis
• Temporary or permanent loss of eyelashes
• As part of the procedure, eye irritation, eye pain, eye itching,discomfort, and in rare cases, Eye infection or temporary blindness can occur.
• Even though the certified eyelash extension professional applies or removes the eyelash extensions using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s or practitioner for follow-up care and subsequent removal of the eyelash extensions.

***Do NOT Wait!! If you have any of the above, You shall consult a health care practitioner or physician at the first sign of infection or allergic reaction at your own expense. We request that you notify us of any diagnosed infection, allergic reaction , or adverse reaction as a direct result of eyelash extensions so we can keep records on file.

Acknowledgements:

       I understand that any time the skin barrier is compromised; there is a small risk of infection. I will contact my aesthetician immediately should this happen.

       The Eyelash Extension treatment has been fully explained and any questions or concerns that I have, have been addressed.

       I acknowledge that no guarantee has been given to me as to the result/improvement expected following treatment, due to each individual’s unique reactions.

       I acknowledge this procedure is strictly an elective cosmetic procedure and that no medical claims have been expressed or implied.

       Photographs May be taken for comparison for future treatments for my chart.

 

I have read the above and understand it. My provider has answered my questions satisfactorily. I accept the possible risks and complications of the treatment.

 

I acknowledge that Lavender Falls Face and Body Spa has a no-refund policy on any products or service. There will be no refunds for any reason.

 

All services performed are without any guarantee. By continuing with service, you are confirming that you have read and understand our no refunds policy.

 

 

 

 

 

Lavender Falls Face and Body Spa LLC

Thank you for choosing and trusting Lavender Falls Face & Body Spa LLC for your aesthetic needs

Feel free to contact us at 210-446-0903 if you have any questions

 

           

 

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Document name: Eyelash
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April 8, 2017 8:11 pm CSTEyelash Uploaded by Lavender Falls Face and Body Spa LLC. - lavenderfallstx@gmail.com IP 162.198.97.65