Name * First Name Last Name Pronouns * She/Her He/Him They/Them Date of birth * Must be 18+ or have consent from Parent/Guardian MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Have you had eyelash extensions before? * Yes, I currently have eyelash extensions. Yes previously, not currently. No, I have never had eyelash extensions. How did you hear about us? * Instagram Google Yelp VoyageSTL Referred by someone If Referred, by who? In case of emergency: * Name and phone number of emergency contact. * I agree to have eyelash extensions applied to my natural eyelashes and/or removed and retouched. By signing this agreement, I consent to the placement and/or removal of the eyelash extensions by the certified eyelash extension professional. * I agree to ocular hygiene service (manual or device assisted) prior to my lashing services or as a stand alone service. I understand that the details of this service will be covered in consultation. I understand this service is not to cure but can assist in the treatment of common eye issues such as dry eye, blepharitis, MGD and lash mites. * I understand that on rare occasions there are risks associated with having artificial eyelashes and eyelash extensions applied to or removed from my natural eyelashes. I further understand that in rare cases as part of the procedure eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes that I will contact the certified eyelash extension professional that performed this procedure and my doctor for treatment. Removal is not always the best option, as it can cause additional irritation. I am aware that information on allergic reactions and the steps to take will be discussed with me during my consultation and are available on the Lash Narrative website. * I understand and consent to having my eyes closed and covered for the duration of approximately 60-180+ minute procedure. Times may vary depending on the type and number of eyelashes applied. Mention this sentence and receive five dollars off. I understand that I am expected to also remain as still as possible during the service and to inform my technician of any discomfort or need to move at any time. I am informing the certified eyelash extension professional of the following conditions by marking with a check mark. * You may not be a candidate for eyelash extensions, lash lifts or brow services due to some previous services, conditions or medications. Current use of contact lenses which I may be asked to remove during the procedure Current use of anything such as oil-containing sunscreen or moisturizer around the eyes Current use of eye drops of any kind, prescription or over-the-counter Current allergies or sensitivities History of recurrent eye or tear duct infections History of dry eyes or Sjorgen’s Syndrome Recent history of Chemotherapy Blephroplasty (eye lift) Alopecia Thyroid disease Pregnancy (consent from OB/GYN required) Child birth within the last 120 days (consent from OB/GYN required) Recent high fever or severe illness Iron Deficiency Hormonal imbalance or extreme stress Major surgery within the last 120 days (Drs release may be required) Any other medical conditions which would prohibit or compromise placement and retention of eyelash extensions Extensive facial treatments such as peels less than 1-4 weeks prior to lash or brow services. Tattoo/Permanent Makeup such as microblading or eyeliner less than 1-2 weeks prior to lash or brow services. ( this is an open wound and lash or brow services can not be performed with recent PMU. ) None of the listed items apply to me If applicable, please list any other conditions, medications or additional information necessary. * I agree to arrive to my future appointments with clean, make up free lashes to get the most out of my service. I understand that arriving with dirty lashes will take away from my application time, and there is additional fees for makeup removal. * I agree to give 1 week notice of cancellation or request to reschedule prior to appointment date. If notice is not given at least 24hrs in advance I am aware that I am subject to a cancellation/rescheduling fee. * I am aware that a no show or late fee will be changed if I am late or fail to arrive at my appointment without notifying my artist. If I am running late I agree to notify my artist and understand that my artist has the right to determine a grace period and if they will be accepting a late arrival or require the appointment to be rescheduled. If I arrive and am unable to receive services due to time constraints or any other reasons prohibiting my artist from completing my service I am subject to the cancellation/rescheduling fee I understand that I am not to bring anyone with me for any service, especially children. Children are not allowed in the salon, due to safety and accreditation standards * I am aware that no showing to an appointment without notifying my technician will result in me being permanently banned from booking any future appointments * I am aware that having lash fills done by outside artists without the knowledge or consent of my artist may result in voiding my contract and could effect my future appointments. * I understand that during my consultation, I will be educated of the natural lash cycle, and understand that lash fall out is expected and to maintain full lashes I am to schedule a fill every 2-3 weeks and adhere to the aftercare and maintenance instructions provided to me. * I agree to inform my technician immediately of any issues, concerns or discomfort with my lashes, and waive my artist and Lash Narrative of any and all liability. * I agree to only return to my technician for removal of my lashes and will not attempt to remove them on my own unless instructed to do so by my technician. I understand that I void my contract if I apply strip lashes over my extensions as this is damaging. Alternative Lash Services including: Lash Lifts, Lash tints and temporary lash applications * I authorize my artist to perform any of the above mentioned alternative lash services now and at any future appointments. I have been made aware of the risks, possible reactions and possibility of eye irritation due to the use of chemicals in the eye area. I have also been made aware of the aftercare instructions Brow Services * I authorize my artist to perform brow services including but not limited to: brow waxing, tinting, lamination or extensions, now and at any future appointments. I have been made aware of the risks, possible reactions and possibility of irritation due to the use of chemicals on the skin and around the brow area I authorize before and after photos to be taken and displayed in the salon and on social media * ****Before photos are required for every client and will be taken to keep in your file for documentation and measurement purposes, these will not be posted to any social media without the above authorization. YES NO Sick Policy * If you actively have or have recently (within the last 2-4 weeks prior to any appt) had the common cold, flu, Covid or other contagious illnesses at the time of your appt, please kindly ask to reschedule. Out of respect for your technician and other clients to prevent spreading any illness. If you arrive to your appt, and either state you are currently sick, have recently been sick or show signs or symptoms (coughing, sneezing, runny nose, etc.) your technician reserves the right to refuse services. Keep in mind lashing involves working around your eye, a mucus membrane. The most common way to catch a cold is via the eyes. Lash Studio Rules * EVERYONE from all walks of life are welcome, ALWAYS! RESPECT EVERYONE!! WE Embrace diversity and inclusivity! Hate speech, negative or derogatory remarks about yourself or anyone else will NOT be tolerated! LOVE, RESPECT AND BE KIND TO YOURSELF! you come to feel beautiful but what's inside is most important. Be sure all you say about yourself is only positive. Because YOU ARE BEAUTIFUL!! LOVE, RESPECT AND BE KIND TO OTHERS!! Kindness is free and simple to give. There's no room here for hate or negativity of any kind! Politics and religion are not appropriate topics of conversation. This falls under respect, everyone has their own beliefs, views and opinions on both of these topics. I respect everyone's choices, views and beliefs, so therefore please respect my choice to not discuss these topics. This is a safe space. I want to ensure every client that anything discussed in the lash chair, stays in the lash chair. This is your safe space, always. * This agreement will remain in effect for this procedure and all future appointments conducted by the licensed and/or certified Aesthetician/eyelash extension professional. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement I verify that I am 18 years of age (under 18 requires parental consent) and consent agreement and for my technician to proceed with my service and all future services. * YES Consent from Parent/Guardian Signature * by typing your first and last name as an electronic signature you verify the above information and waive the artist(s) and Lash Narrative of any and all liability. Date MM DD YYYY Thank you! Your consent form will be reviewed by your artist. You will be contacted if additional information is needed. Look forward to lashing you! 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