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.

24-Hour Cancellation Policy:

We require a minimum of 24 hours' notice for any appointment cancellations or rescheduling. Failure to provide at least 24 hours' notice, or missing your scheduled appointment, will result in the forfeiture and deduction of that session from your pre-paid package.

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

24-Hour Cancellation Policy:

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