Consent Form

Your name

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Preferred day for fills?

Booking before or after 12pm?
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Did somebody refer you? If so please say who:

Your birth date:

By agreeing to the terms of this consent form I confirm that I HAVE BEEN WARNED THAT:

I should not wet my eyelash extensions within the first 8 hours because the adhesive needs to set.
I should not rub or be rough with my eyes or eyelash extensions after the application.
The longevity of my extensions will depend on many variables including the technician’s expertise, my personal lash/hair growth, how well I care for my eyelash extensions and my use of oil based products.
The use of oil based products (including sunblock, eye creams, mascara, eyeliner and make-up remover) on the lash line will shorten the life span of my eyelash extensions because oil based products are used to remove the eyelash extensions.
I should use an oil free make up remover or foaming cleanser.

I CONFIRM THAT I HAVE READ AND UNDERSTOOD THESE COST IMPLICATIONS:
Depending on my lash growth, aftercare touch up appointments may be necessary after the first 2 to 3 weeks at an additional fee. I should return when I still have 75% of my Eyelash Extensions left. If, on my next I only have 20% of my lashes shed, or, if 4 weeks have passed since my last eyelash extension application, the price of a full set of lashes will be charged for the touch up. These charges will be confirmed before any eyelash extensions are applied.

The therapist is bound to an appointment schedule and if I’m late the therapist will endeavor to complete the procedure on time and the charge will remain the same – I am aware that part of the procedure may be compromised in order to finish on time (less lashes applied)
I am aware that arriving with already clean lashes will save time and allow for greater lash extension application time.

A flat fee of R200 will be charged for the removal of another technician’s incorrectly applied lashes, please note this takes up to 30 minutes and will cut into your application appointment.

IMPORTANT DISCLAIMER:
By agreeing to the terms of this consent form, I waive any claims whatsoever that I may have against The Urban Beauty Lounge and/or any of its employees, technician’s, agents, suppliers resulting from any potential adverse reaction that I may have to any of the products used in the procedure, regardless when this reaction might occur. It has been found that 1% of the population may become sensitive to certain agents in the adhesive, over time.

What look are you hoping to achieve?
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Today's date:

By clicking "AGREE" below I am acknowledging that I have read and understood the above warnings and disclaimers. If I do not click agree my appointment cannot proceed.

Full Name:

AGREE:

(if you have not clicked AGREE the 'send' button will not activate)

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