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  • Consent Form

    Încărcat de

    api-288465930
    181 vizualizări1 pagină
    By signing this agreement, I consent to the placement and removal of eyelash extensions by Laura Zang. I understand there are risks associated with having eyelash extensions applied to, or removed from my natural eyelashes. As part of the procedure, eye irritation, eye pain, eye itching, discomfort, and (in rare cases) eye infection or blindness can occur. ____i understand and consent to having my eyes closed and covered for the duration the procedure.

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    By signing this agreement, I consent to the placement and removal of eyelash extensions by Laura Zang. I understand there are risks associated with having eyelash extensions applied to, or removed from my natural eyelashes. As part of the procedure, eye irritation, eye pain, eye itching, discomfort, and (in rare cases) eye infection or blindness can occur. ____i understand and consent to having my eyes closed and covered for the duration the procedure.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    181 vizualizări1 pagină

    Consent Form

    Încărcat de

    api-288465930
    By signing this agreement, I consent to the placement and removal of eyelash extensions by Laura Zang. I understand there are risks associated with having eyelash extensions applied to, or removed from my natural eyelashes. As part of the procedure, eye irritation, eye pain, eye itching, discomfort, and (in rare cases) eye infection or blindness can occur. ____i understand and consent to having my eyes closed and covered for the duration the procedure.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 1

    I___________________________agreetohaveeyelashextensionsappliedtomynaturaleyelashesand/orhavethemremovedandretouched.

    By
    signingthisagreement,IconsenttotheplacementandremovalofeyelashextensionsbyLauraZang.
    ____Iunderstandtherearerisksassociatedwithhavingeyelashextensionsappliedto,orremovedfrommynaturaleyelashes.Ifurtherunderstand
    thataspartoftheprocedure,eyeirritation,eyepain,eyeitching,discomfort,and(inrarecases)eyeinfectionorblindnesscanoccur.IagreethatifI
    experienceanyofthesemedicalconditionswithmylashesIwillcontactthecertifiedeyelashextensionsprofessionalandhavetheeyelashesremoved
    immediatelyandconsultaphysicianatmyownexpense.
    ____IunderstandthateventhoughLauraZangappliesorremovestheeyelashextensionsusingthepropertechnique,theinstruments,tapes,cleaners,
    eyegelpads,adhesives,andremoversusedmayirritatemyeyesorrequireaphysiciansfollowupcareandsubsequentremovaloftheeyelash
    extensionsatmyownexpense.
    ____Iunderstandandagreetothecareinstructionsprovidedbythecertifiedeyelashextensionprofessionalfortheuseandcareofeyelashextensions.
    Irealizeandaccepttheconsequencesoffailuretoadheretotheseinstructionsmaycausetheeyelashextensionstofallout,damagetheextensions
    (possiblythenaturallashestoo)and/ordecreasesthetimethelasheswilllast.
    ____Iunderstandandconsenttohavingmyeyesclosedandcoveredforthedurationtheprocedure.
    ____IaminformingLauraZangofthefollowingconditionsbymarkingwithacheck:
    o
    o
    o
    o

    Currentuseofcontactlenses
    Currentadhesiveandotherallergies
    Historyofclaustrophobia
    Othermedicalconditionswhichcompromiseplacementeyelashextensions

    ____Iagreetothefollowingeyelashextensionpostopandmaintenanceinstructions:
    o
    o
    o
    o
    o
    o

    Nowaterproofmascara
    Avoidwearingmascaraatall,asthiswilllessenthelifeofyourextensions
    Avoidprescriptionoroverthecountereyedrops(duetocoatingextensions)
    Nooilbasedproductsaroundtheeyearea
    Nowatercancomeincontactwiththeeyeareafor24hoursoftheapplication
    Nocontinuouspullingorrubbingofthesyntheticlashes

    ThisagreementwillremainineffectforthisprocedureandallfutureproceduresconductedbyLauraZang.Iamover18yearsofageandconsenttothe
    agreementandtotreatment.IunderstandthattheutmostattentiontosafetyandproperapplicationhasbeenpaidusingtoolsandproductsthatLaura
    Zanghasbeenprofessionallytrainedtouse.Thereisnoguaranteeforthebondingtimeoftheeyelashextensions.Iunderstandtheaftercare
    instructionsandwilldomyparttomaintainmyeyelashextensions.Iunderstandthattherearemanyfactorsthatmayaffectthelifeoftheeyelash
    extensionssuchaswaterandmoisturecontact,weatherconditions,andactivitiesinvolvingexposuretohightemperatures.Bysigningbelow,Iverify
    thatIhavereadandunderstandtheabovestatementsandagreetothem.
    __________________________________________________Date____/____/____
    Signature
    LauraZangisgrantedtotakebeforeandafterphotosofmyeyes/facewhichmaybeusedformarketingpurposesonawebsite,salon,orclass.
    __________________________________________________Date:____/____/____
    Signature

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