Surveypoint

Q1

First Name

Client

Q2

Last Name

Client

Q3

Phone Number

Q4

Email

Q5

By checking the following boxes, confirm that you willingly consent to the following terms and conditions:

I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.

I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.

I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.

I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2 to 3 weeks to keep them full.

Q6

By checking the following boxes, confirm that you willingly consent to having the treatment during the COVID-19 pandemic:

I am aware of the risks of having hair services during the pandemic.

I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.

I will follow the rules in order to minimize the spread of viruses. I understand that I must sanitize my hands before entering the salon and I must wear a mask that covers my mouth and nose while in common areas.

I confirm that I have not travelled domestically or internationally via public transportation within 14 days.

I do not have any of the following COVID-19 symptoms: cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste, loss of smell.

I have not contacted with anyone that have or may have COVID-19 symptoms or get infected within past 14 days.

I understand I may NOT bring children or anyone else who does not have an appointment into the salon.

I will immediately notify the salon if I contract the virus within two weeks following my visit.

Q7

Date

Q8

Eyelash Extension Consent And Appointment -Form Fill