Lash Lift Consent Form

I understand that there are risks associated with the CurlPerfect Lash Lift procedure.

I understand that the lashes will be curled with an advanced solution and a conditioning cream.

I understand that as part of the procedure eye irritation, pain, itching discomfort and in rare cases eye infection may occur.

I understand and agree to follow the aftercare instructions provided by my technician.

I understand failure to follow the aftercare instructions may cause an undesirable result.

I understand that in order to have a CurlPerfect Lash Lift, I will need to keep my eyes closed for duration up to 60 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean that I will not be able to have the procedure performed on my eyes.

I understand that opening my eyes at any point during the CurlPerfect Lash Lift procedure is not recommended, and may cause an undesirable result. I agree to keep my eyes closed throughout the procedure unless instructed to open them by my technician.

This agreement will remain in effect for this procedure and all future CurlPerfect Lash Lift procedures conducted by my technician or any other technician conducting business at the salon/spa listed below.

I understand that this agreement is binding and that I have read and fully understand all information above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

I release my technician or salon/spa from all liability associated with this procedure. There are no guarantees for how long the lash lift will last, on average it last between 6-8 weeks. Our company or salon is not responsible for any technician errors.

I understand that I have been advised to follow the aftercare protocol from my technician so as to avoid any discomfort or adverse side effects after the procedure has been completed.

Consent for Treatment -I understand that, because esthetics involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

Initial Here

By signing below, I verify that I have read and understand the above statements and agree to them.

I hereby consent to and authorize the Polished Technician to perform treatments at Polished Spa

Signee Information

First Name *

Last Name *

Phone *

Email Address

Address *

Address Line 2

City *

State *

Zip *

Photo Consent*

Yes

Do you have any allergies to Acrylates or Cyanoacrylates*

List any allergies you have:*

Are you currently using any prescription or over-the-counter medications?*

Yes

If yes, please specify:*

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

Lash Lift Consent Form

Signee Information

Please enter participants' full names: