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Lash Lift & Tint Consent Form Template

Create a Secure and Informative Experience for Clients

Are you struggling to ensure your clients feel safe and informed during their lash lift services? This Lash Lift & Tint Consent Form Template helps you streamline the process while ensuring legal protection and client satisfaction. By using this template, you'll collect necessary client information, clarify potential risks, and provide a clear outline of your lash lift services-all while enhancing trust and professionalism in your practice. Plus, it's easy to customize to suit any salon's needs. Try the live template to get started on transforming your client experience.

Use this Template (FREE) Live Preview
Client full name
Date of birth
Email address
Mobile phone number
Emergency contact full name
Emergency contact phone number
Age confirmation
I am 18 or older
I am under 18 and have parent/guardian consent
I am under 18 and do not have consent
Which services are you consenting to today?
Lash lift
Lash tint
Patch test status with our salon
Yes, within the last 48 hours
Yes, within the last 7 days
Yes, more than 7 days ago
No
Not sure
If you choose to proceed without a recent patch test, you understand there is an increased risk of sensitivity or reaction
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Do you wear contact lenses?
Yes
No
Are you currently pregnant or breastfeeding?
Pregnant
Breastfeeding
Neither
Prefer not to say
Do you have any known allergies to tint, hair dye, adhesives, latex, or chemicals?
Yes
No
Please list any known allergies
Any eye conditions or infections within the past 4 weeks (e.g., conjunctivitis, stye, blepharitis)?
Yes
No
Any eye surgery, laser, or cosmetic procedures around the eyes within the last 6 months?
Yes
No
Other medical information we should be aware of
Are you currently using lash growth serums or prescription eye drops?
Yes
No
Have you had a lash lift or tint before?
Yes
No
Did you experience any sensitivity or reactions from previous lash services?
Yes
No
Desired outcome for this appointment
Subtle lift
Defined curl
Tint only
Lift and tint
Unsure - please advise
Photo consent for before and after images
Yes, eyes only
Yes, full face
No
I understand the procedure involves applying lifting and tinting products near my eyes
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand potential risks, including irritation, allergic reaction, dryness, over-processing, or uneven results
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will follow aftercare instructions, including keeping lashes dry for 24 hours and avoiding oil, steam, and rubbing
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I have provided accurate and complete information to the best of my knowledge
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Client signature (type full name)
Signature date
Parent or guardian name (if client is under 18)
{"name":"Client full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Client full name, Date of birth, Email address","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration featuring a lash lift and tint consent form for beauty services.

When to use this form

Use this form before any lash lift, tint, or combined appointment, including during your lash lift consultation. It suits solo artists, salons, and mobile teams. For first-time clients, it confirms medical history, allergies, lens use, and patch testing so you can proceed safely. For returning clients, it notes changes since the last visit and documents aftercare consent. Pair it with the Esthetician client intake form to capture general details, and keep this form focused on eye-related risks and photos. Multi-service studios can align policies alongside the Waxing consultation form or the Dermal filler consent form. The result: fewer reactions, clear expectations, and signed consent that protects you and your client.

Must Ask Lash Lift & Tint Consent Questions

  1. Do you have any eye conditions, allergies, or past reactions to lash services, hair dye, latex, or adhesives?

    This flags contraindications and helps you choose safer products or postpone the service. It reduces the risk of irritation, swelling, or chemical burns.

  2. Are you pregnant or breastfeeding, have glaucoma, recent eye surgery, blepharitis, or using medications like Accutane, Retin-A, or lash growth serums?

    These factors change sensitivity and processing time, and some are not suitable for lifts or tints. Documenting them guides your decision and protects client safety.

  3. When was your last lash lift, tint, or extensions, and have you completed a 2448 hour patch test for today's products?

    This prevents over-processing fragile lashes and confirms product tolerance. It also shows you followed a patch-test policy if a reaction occurs.

  4. Do you wear contact lenses, and will you remove them before the service?

    Removing lenses lowers the chance of irritation or trapping solution under the lens. It also reminds the client to bring a case and solution.

  5. Do you understand the procedure risks and aftercare, and do you consent to before/after photos for records or marketing?

    This sets expectations about results, maintenance, and possible side effects. Photo consent keeps your portfolio compliant and gives you permission to use images.

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