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Eyelash Extension Consent Form Template

Streamline your lash extension process with this essential consent form

Ensuring your clients understand the eyelash extension procedure is crucial for a successful appointment. This consent form template helps you communicate potential risks, the techniques used, and the benefits clients can expect. With clear terms and absolution of liability, you protect yourself and build trust, while simultaneously simplifying documentation for your lash services, improving client relations, and enhancing customer satisfaction. Experience the ease of customization with our live template as you create a professional lash consent form.

Client full name
Phone number
Email address
Emergency contact full name
Emergency contact phone number
Do you have any known sensitivities or allergies to any of the following?
Cyanoacrylate (lash adhesive)
Acrylates
Latex
Medical tape
Gel pads or eye patches
None of the above
Unsure
Have you ever experienced an adverse reaction to eyelash extensions or lash lift/perm?
Yes
No
Do you currently have or have you recently had any of the following conditions?
Please list any medications, supplements, or conditions that may affect sensitivity or healing (e.g., Accutane, Retin-A, blood thinners, thyroid conditions).
Are you currently pregnant or breastfeeding?
Pregnant
Breastfeeding
No
Prefer not to say
Have you had eyelash extensions before?
Yes
No
Desired lash look
Natural
Classic
Hybrid
Volume
Mega volume
Not sure
Patch test preference
I request a patch test at least 24-48 hours before my appointment
I decline a patch test and accept the associated risk
Patch test completed within the last 6 months with no reaction
I understand that lash adhesives contain cyanoacrylate and other ingredients that may cause sensitivity or allergic reactions.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand potential risks include irritation, redness, itching, burning, infection, and temporary damage to natural lashes.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will inform the technician immediately if I experience any discomfort during the service.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will keep my lashes dry and avoid steam and oil exposure for the first 24-48 hours after application.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will remove contact lenses before the service and bring a case if needed.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I confirm the information provided is accurate and complete.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I consent to the application, maintenance, and removal of eyelash extensions by the provider.
Yes
No
Photo release
I consent to use of my before/after photos for marketing, including website and social media
I consent to use of my photos for internal records only
I do not consent to any use of my photos
Parent/guardian full name (if applicable)
Client signature (type full name)
Date signed
Age and consent status
I am 18 or older
I am under 18 and have parent/guardian consent
I am under 18 and do not have parent/guardian consent
{"name":"Client full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Client full name, Phone number, Email address","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Artistic paper illustration related to eyelash extension consent form template for FormCreatorAI article

When to use this form

Use this consent form when onboarding new lash clients, documenting medical history and risks before you apply a full set, fill, or removal. It helps your studio, mobile techs, and salons reduce liability and prevent reactions by confirming allergies, eye conditions, aftercare, and photo consent. Send it with booking confirmations or have clients sign on a tablet in-studio. If you also manage bookings, pair it with the Eyelash extension appointment form. Offer add-on services? Keep client health details aligned across treatments with the Facial treatment consultation form and the Makeup appointment form. For businesses with multiple services, a shared intake flow keeps records consistent and speeds check-in.

Must Ask Eyelash Extension Consent Questions

  1. Do you have any allergies or sensitivities to adhesives, latex, cyanoacrylate, or eye products?

    Allergy disclosure helps you choose the right glue or patches, or postpone service to avoid reactions. It protects your client and reduces emergency situations in the chair.

  2. Do you have any current eye conditions or recent procedures (infection, stye, dry eye, glaucoma, LASIK, surgery)?

    Eye issues raise the risk of irritation or infection during application. This detail guides you to modify technique, use gentle products, or require medical clearance.

  3. Do you wear contact lenses, and will you remove them for the service?

    Contacts can trap fumes and cause discomfort. Confirming removal prevents irritation and reminds clients to bring a case and solution.

  4. Do you want a 24-48 hour patch test, and do you agree it may affect scheduling?

    A patch test can reveal sensitivities before a full set, reducing adverse reactions. If needed, schedule it via your Eyelash extension appointment form so expectations are clear.

  5. Do you acknowledge the risks, aftercare steps, and consent to treatment and optional photography for records/marketing?

    Written acknowledgment improves retention and safety by ensuring clients follow aftercare and understand fills and limits. It also secures consent for photos, protecting your business.

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