Lash & Brow Tint Consent Form
Although every precaution will be made to ensure your safety and well-being before, during, and after your tinting application, please be aware of the possible risks below. Please initial:
_____ I understand that tinting my eyelashes or eyebrows may have some risk of irritation to the orbital eye area, including, but not limited to the eye itself. If tint enters the eye, it can result in a stinging or burning sensation, blurred vision, and in severe cases blindness if the eye is not immediately flushed.
_____ I understand that if the tinting agent, developer, or mixture of both gets into with my eye, then my eye
will be flushed with sterile eyewash and medical attention may be required.
_____ I understand that if the tint encounters the skin, then irritation or a sensation of itching or burning may occur.
_____ I understand that there may be some residual tint staining left on the skin following the tinting process of either my lashes, brows, or both. I understand that this fades away.
_____ I understand that, while every attempt will be made to provide me with my chosen color, there are many factors on how hair absorbs color and my results may not be the color I initially requested.
_____ I understand that over the course of several weeks, the tint will gradually lighten and fade. I understand that natural eyelashes have a growth cycle and my natural eyelashes grow and shed. Re-tinting is required to keep the intensity of the color. I understand that maintenance is recommended every 3-4 weeks.
_____ I understand that for the purposes of documentation “before and after” photographs will be taken.
These photos are kept in my file and not shared without my permission.
_____ I give LIBERTY LAKE LASHES permission to use photographs taken of me for advertisement purposes or portfolio development. (Optional)
I have read the above information. If I have any concerns, I will address these with my stylist immediately. I give permission to my stylist to perform the tinting procedure we have discussed and will hold (Stylist Name) or LIBERTY LAKE LASHES harmless from any liability that may result from this treatment. I have accurately answered the questions on the Client Intake Form, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my stylist will take every precaution to minimize or eliminate negative reactions. If I have additional questions or concerns regarding my treatment, I will consult my stylist immediately.
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I had sufficient opportunity for discussion of the process and all my questions are answered. I understand the service and accept the risks. I do not hold the stylist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this tinting service, which may be affected by the treatment performed today. I acknowledge this agreement for all eyelash and eyebrow tinting services received within a year from the signing date.
Client Name (Printed):
Client Signature: Date:
Service Provider Signature: Date: