LVL Lash treatment consent form

Contraindications & Medical Disclosure

First Name

Last Name

Phone *

Email *

Please check any that apply:

Eye infection (conjunctivitis, stye, blepharitis)

Recent eye surgery (within last 6 months)

Extremely sensitive skin or eyes

Allergies to cosmetics, adhesives, or hair dyes

Recent permanent makeup around eyes

Contact lenses (will be removed before treatment)

Pregnancy or breastfeeding

Using Retin-A, Accutane, or similar medications

Other medical conditions (please specify):

I confirm that

the above information is true and complete to the best of my knowledge.

Patch Test:

I have had a patch test at least 24–48 hours prior to this treatment and experienced no reaction.

I decline a patch test and understand I am proceeding at my own risk.

I understand

that allergic reactions can occur even with a negative patch test.

Possible Risks & Side Effects

I understand that

although rare, the following may occur:

Eye irritation or redness
Watery eyes
Allergic reaction
Over-processing or lash damage
Sensitivity to tint
Unsatisfactory results

I understand

results may vary depending on lash length, thickness, and aftercare.

Aftercare Acknowledgment

I understand that

for the first 24–48 hours after treatment I must:

Keep lashes dry
Avoid steam, saunas, and swimming
Avoid mascara or eye makeup
Avoid rubbing the eyes
Avoid oil-based products around the eye area
Failure to follow aftercare instructions may affect results.

Consent & Liability Release

I voluntarily

consent to the LVL Lash Lift and Tint treatment.

I acknowledge

that the procedure has been explained to me and I have had the opportunity to ask questions.

Client signature:

Clear

Practitioner signature:

Clear

Date

I release the lash technician and business from liability for any adverse reactions or dissatisfaction resulting from the treatment, except in cases of negligence.

I confirm that I am over 18 years of age (or have parental/guardian consent)

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LVL Lash treatment consent form

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