Purely Polished Lash Lift & Extensions Consent Form

Before my qualified professional eyelash technician can perform this procedure I understand I must complete this agreement and provide my consent by ticking the box on my booking request form.

I agree to and understand the the following statements:

  1. I agree to having an eyelash lift / eyelash extensions applied and / or removed from my eyelashes.

  2. There are risks associated with having lash lifts / artificial eyelashes applied to / and or removed from my natural eyelashes

  3. As part of the procedure eye irritation, eye pains, eye itching, discomfort and in rare cases eye infection may occur. If I experience any of these issues with my lashes, I will contact my technician (and have eyelashes extensions removed) immediately and consult a physician at my own expense

  4. Even though the technician may apply and remove the lash extensions properly / perform the lift properly, adhesive materials may become dislodged during or after the procedure, which may irritate my eyes or require further follow up care.

  5. I will follow the after care instructions provided by my technician. Failure to follow the after care instructions can cause the eyelash extensions to fall out / for my lash lift to not be as effective.

  6. In order to have eyelash extensions applied to my eyelashes / have my lashes lifted I will need to keep my eyes closed for the duration of 60-100 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 I will not be able to have the procedure performed on my eyes.

  7. Eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash / Lashes will be lifted into a position determined by the technician thereby preserving the health, growth and natural look of the natural lashes.

  8. I request and consent to these procedures being carried out without undergoing a sensitivity patch test. The sensitivity test which if conducted may indicate my sensitivity/allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and service(s).

  9. If I have the following conditions or/am the following I must let my technician know and I may not be eligible for the procedure:

  • On the contraceptive pill

  • Eye disease

  • Pregnant

  • Inflammation of the skin placeholder

  • Blepharititis

  • HRT

  • Contact lenses

  • Thyroid conditions requiring medication

  • Recent eye surgery

  • Oily skin and hair

  • Skin disorders

  • Eye infections

  • Water eyes

  • Bell’s palsy

  • Hay fever

  • Previous reactions to eye treatments

  • Allergies to bonding agents (acrylate/cyanacrylate), adhesives (glues, tapes, bandaids), latex or acetone

  • Undergone chemotherapy in the last 6 months