Eyelash Extension Consent Form

To protect your retention and your appointment time:

Arrive with clean lashes and no eye makeup — no mascara, eyeliner, or shadow.
Avoid oil-based products and eye creams around the lash line for a day or two before.
If you wear contacts, you may want to remove them for your appointment (bring a case).
Skip heavy caffeine right before — it can make the eyes flutter and slow application.
Plan for up to 2+ hours; arrive on time so we don’t have to shorten your set.

To keep your lashes full and lasting:

Keep them dry for 24–48 hours — no water, steam, sweat, sauna, or hot yoga.
Avoid oil-based products and oil-based makeup remover near the lash line.
Don’t rub, pick, or pull at them, and skip the eyelash curler and mascara — you won’t need it.
Cleanse daily with a lash-safe foaming cleanser and brush with a clean spoolie.
Book a fill every 2–3 weeks to keep them looking full.

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Section A — Client Information

First Name *

Last Name *

Phone *

Email *

Date of Birth *

Today's Date *

City

State

Postal Code

Emergency Contact Name

Emergency Contact Phone

I agree to receive booking confirmations and appointment reminders at my email address above. *

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Section B — Photo Release

I consent to before/after photos being taken for use on social media and website.

Name preference for photos

Use my name No name Fictitious name

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Section C — Medical History

List any known allergies

List all current medications

Client preferences for next visit

Additional notes for next session

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Section D — Eyelash Extension Contraindications

Please check any conditions that apply to you. If any box is checked, your technician will review before proceeding.

Current eye infection, conjunctivitis (pink eye), or stye Recent eye surgery (within 6 months) Chemotherapy or radiation therapy to eye area Known allergy to cyanoacrylate (lash adhesive) or formaldehyde Alopecia or medical condition causing lash loss Extremely sensitive, watery, or dry eyes I wear contact lenses (must be removed before service) Trichotillomania (compulsive lash/hair pulling)

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Section E — Client Consent & Signature

Appointment reminders: I consent to receive appointment reminder messages via SMS from I Am Beautiful by Mia. Message & data rates may apply. Reply STOP to opt out. Promotions: I consent to receive promotional and marketing messages (special offers, product updates) from I Am Beautiful by Mia. Message & data rates may apply. Reply STOP to opt out.

By checking the SMS boxes above, you agree that I Am Beautiful by Mia may contact you at the number provided. This is not a condition of service.

Before Your Appointment

Aftercare

Section A — Client Information

Section B — Photo Release

Section C — Medical History

Section D — Eyelash Extension Contraindications

Section E — Client Consent & Signature