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CLIENT PROFILE SHEET
Fill out the form below and our team member we get back to you.
Have you ever had eyelash extensions in the past?
Yes
No
ARE YOU PREGNANT?
Yes
No
ARE YOU DIABETIC?
Yes
No
DO YOU HAVE ALOPECIA?
Yes
No
DO YOU HAVE GLAUCOMA?
Yes
No
DO YOU HAVE BLEPHARITIS?
Yes
No
DO YOU HAVE LUPUS?
Yes
No
DO YOU HAVE PSORIASIS?
Yes
No
DO YOU HAVE ANY EYE ALLERGIES?
Yes
No
ARE YOU SENSITIVE TO LIGHT?
Yes
No
DO YOU WEAR CONTACT LENSES?
Yes
No
OR GLASSES?
Yes
No
DO YOU WEAR LATISSE?
Yes
No
HAVE YOU HAD ANY EYE SURGERIES?
Yes
No
Liability Release & Permission
I authorize (QUEEN ANN BROW) to provide and apply semi-permanent eyelash extensions. In order to minimize risk of eye injury, I understand that it is my responsibility to remain completely still for the entire eyelash extension procedure or until otherwise directed by the Lash Artist. I have been fully informed regarding the methods and procedures used in the application of semi-permanent eyelash extensions. All risks and potential complications, including but not limited to redness, irritation, and allergic reactions to either the adhesive and or eye pads, have been fully disclosed to me. I certify that I understand these risks and potential complications, and that I knowingly and voluntarily consent to the application of semi-permanent eyelash extensions.
If at any time I feel uncomfortable during the lash procedure, I agree to immediately notify the Lash Artist. The Lash Artist will seek to remedy the problem, including ending the session if it is deemed prudent by the Lash Artist. I acknowledge that no guarantees or promises regarding the appearance or longevity of the lash extension have been made. I hereby certify that I have disclosed all conditions regarding my health history, medications and past reactions to products, treatments and medications in connection with the Confidential Client Profile and Consultation Form.
I agree to use only recommended products on my eyelash extensions and fully understand that careful maintenance is also required.
During the initial 24-48 Hours, I agree to:
Avoid getting the lashes wet for the first six to eight hours following my lash extension application. Avoid steam from showers, saunas and swimming pools, and avoid suntan beds for 48 hours following the application. I understand that using a sealer can extend the life of the extensions.
I certify that I understand, and agree to comply with the following instructions with respect to the care of my lash extensions:
Avoid oil based skincare, mascara and cleansing products. ONLY water-based oil-free products are approved. Oil based products, including oil-based eyeliner, will affect the adhesion and cause the lashes to fall out prematurely. Only approved lash extension mascara is permissible. Oil-based and or waterproof mascara will interfere with the adhesive bond with disastrous results. Keep your fingers off your lashes. Every time you touch them you are transferring natural oil and GERMS. Brush your lashers with a mascara wand to groom your lashes, ideally when your lashes are wet or when you step out of the shower. The lashes will be softer and suppler. Do not use mechanical eyelash curlers, they will break the bond. Use a clean mascara wand to support your lashes and curl lashes in an upward motion. When cleaning your lashes, gently rub them between your forefingers and thumb using ONLY approved make-up or mascara remover / cleaner. Inform all your service providers regarding your semi-permanent lash extensions when going for facial work. Caution is recommended when having services such as lasers, chemical peels, hydroxyl treatments, or any other acidic substances applied to your face. Do not use Latisse or any other lash growth stimulator while wearing eyelash extensions.
I understand that the natural lash cycle is 60-90 days. When one lash falls out, there is another lash growing in. I, therefore, understand that I will need regular refills (every 3-6 weeks) to keep my lashes looking beautiful. I understand that variables, including the natural lash cycle and customer care, will influence the longevity of eyelash extensions.
BY SIGNING THIS CUSTOMER WAIVER AND RELEASE AGREEMENT, I THE CLIENT NAMED BELOW CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE (QUEEN ANN BROW) AND ITS DIRECTORS, OFFICERS, OWNERS, EMPLOYEES, AGENTS AND REPRESENTATIVES FROM ANY AND ALL CLAIMS FOR DAMAGES FOR PERSONAL INJURY ARISING FROM THE APPLICATION AND USE OF SEMI-PERMANENT EYELASH EXTENSIONS, INCLUDING ANY DAMAGES RELATING TO KNOW OR UNKNOWN COMPLICATIONS WHICH MAY ARISE DURING OR FOLLOWING THE APPLICATION PROCESS INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE. I FURTHER RELEASE AND HOLD HARMLESS (QUEEN ANN BROW) FROM ANY CLAIMS RELATING TO PREEXISING CONDITIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE.
I AGREE THAT ANY DISPUTES BETWEEN (QUEEN ANN BROW), SHALL BE SETTLED BY ARBITRATION ADMINISTERED BY THE AMERICA ARBITRATION ASSOCIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES, AND JUDGMENT ON THE AWARD RENDERED BY THE ARBITRATOR (S) MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF THE PREVAILING.
PARTY SHALL BE ENTITLED TO REASONABLE ATTORNEY FEES AND ARBITRATION COSTS INCURRED IN CONNECTION WITH ENFORCING THIS ARGREEMENT.
I certify that I have read and fully understand this Customer Waiver & Release Agreement. I further certify that I have completed the Client Confidential Profile accurately and completely to the best of my knowledge, and that I understand the potential complications and risks described herein. I hereby authorize (QUEEN ANN BROW) to provide and apply semi-permanent eyelash extensions to my own natural lashes, in accordance with the terms and conditions set forth in this Customer Waiver and Release Agreement.
NOTE: IF YOU ARE TAKING A PRENATAL DAILY, USING BIOTIN OR A LASH GROWTH STIMULATOR, THEN YOUR LASH EXTENSIONS WILL GROW OUT FASTER THEN NORMAL.Liability Release & Permission
I authorize (QUEEN ANN BROW) to provide and apply semi-permanent eyelash extensions. In order to minimize risk of eye injury, I understand that it is my responsibility to remain completely still for the entire eyelash extension procedure or until otherwise directed by the Lash Artist. I have been fully informed regarding the methods and procedures used in the application of semi-permanent eyelash extensions. All risks and potential complications, including but not limited to redness, irritation, and allergic reactions to either the adhesive and or eye pads, have been fully disclosed to me. I certify that I understand these risks and potential complications, and that I knowingly and voluntarily consent to the application of semi-permanent eyelash extensions.
If at any time I feel uncomfortable during the lash procedure, I agree to immediately notify the Lash Artist. The Lash Artist will seek to remedy the problem, including ending the session if it is deemed prudent by the Lash Artist. I acknowledge that no guarantees or promises regarding the appearance or longevity of the lash extension have been made. I hereby certify that I have disclosed all conditions regarding my health history, medications and past reactions to products, treatments and medications in connection with the Confidential Client Profile and Consultation Form.
I agree to use only recommended products on my eyelash extensions and fully understand that careful maintenance is also required.
During the initial 24-48 Hours, I agree to:
Avoid getting the lashes wet for the first six to eight hours following my lash extension application. Avoid steam from showers, saunas and swimming pools, and avoid suntan beds for 48 hours following the application. I understand that using a sealer can extend the life of the extensions.
I certify that I understand, and agree to comply with the following instructions with respect to the care of my lash extensions:
Avoid oil based skincare, mascara and cleansing products. ONLY water-based oil-free products are approved. Oil based products, including oil-based eyeliner, will affect the adhesion and cause the lashes to fall out prematurely. Only approved lash extension mascara is permissible. Oil-based and or waterproof mascara will interfere with the adhesive bond with disastrous results. Keep your fingers off your lashes. Every time you touch them you are transferring natural oil and GERMS. Brush your lashers with a mascara wand to groom your lashes, ideally when your lashes are wet or when you step out of the shower. The lashes will be softer and suppler. Do not use mechanical eyelash curlers, they will break the bond. Use a clean mascara wand to support your lashes and curl lashes in an upward motion. When cleaning your lashes, gently rub them between your forefingers and thumb using ONLY approved make-up or mascara remover / cleaner. Inform all your service providers regarding your semi-permanent lash extensions when going for facial work. Caution is recommended when having services such as lasers, chemical peels, hydroxyl treatments, or any other acidic substances applied to your face. Do not use Latisse or any other lash growth stimulator while wearing eyelash extensions.
I understand that the natural lash cycle is 60-90 days. When one lash falls out, there is another lash growing in. I, therefore, understand that I will need regular refills (every 3-6 weeks) to keep my lashes looking beautiful. I understand that variables, including the natural lash cycle and customer care, will influence the longevity of eyelash extensions.
BY SIGNING THIS CUSTOMER WAIVER AND RELEASE AGREEMENT, I THE CLIENT NAMED BELOW CERTIFY THAT I KNOWINGLY AND VOLUNTARILY RELEASE (QUEEN ANN BROW) AND ITS DIRECTORS, OFFICERS, OWNERS, EMPLOYEES, AGENTS AND REPRESENTATIVES FROM ANY AND ALL CLAIMS FOR DAMAGES FOR PERSONAL INJURY ARISING FROM THE APPLICATION AND USE OF SEMI-PERMANENT EYELASH EXTENSIONS, INCLUDING ANY DAMAGES RELATING TO KNOW OR UNKNOWN COMPLICATIONS WHICH MAY ARISE DURING OR FOLLOWING THE APPLICATION PROCESS INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE. I FURTHER RELEASE AND HOLD HARMLESS (QUEEN ANN BROW) FROM ANY CLAIMS RELATING TO PREEXISING CONDITIONS I HAVE NOT REVEALED OR CHANGES TO THOSE CONDITIONS SUBSEQUENT TO THE PROCEDURE.
I AGREE THAT ANY DISPUTES BETWEEN (QUEEN ANN BROW), SHALL BE SETTLED BY ARBITRATION ADMINISTERED BY THE AMERICA ARBITRATION ASSOCIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES, AND JUDGMENT ON THE AWARD RENDERED BY THE ARBITRATOR (S) MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF THE PREVAILING.
PARTY SHALL BE ENTITLED TO REASONABLE ATTORNEY FEES AND ARBITRATION COSTS INCURRED IN CONNECTION WITH ENFORCING THIS ARGREEMENT.
I certify that I have read and fully understand this Customer Waiver & Release Agreement. I further certify that I have completed the Client Confidential Profile accurately and completely to the best of my knowledge, and that I understand the potential complications and risks described herein. I hereby authorize (QUEEN ANN BROW) to provide and apply semi-permanent eyelash extensions to my own natural lashes, in accordance with the terms and conditions set forth in this Customer Waiver and Release Agreement.
NOTE: IF YOU ARE TAKING A PRENATAL DAILY, USING BIOTIN OR A LASH GROWTH STIMULATOR, THEN YOUR LASH EXTENSIONS WILL GROW OUT FASTER THEN NORMAL.
ARE YOU TAKING PRENATALS?
Yes
No
ARE YOU USING BIOTIN?
Yes
No
ARE YOU USING A LASH GROWTH STIMULATOR?
Yes
No
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