Can this be signed electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, signer attribution, and record retention are met; include consumer disclosure when services are consumer-facing.

Is a notary or witness required?

Typically no. Consent forms for routine eyelash extensions do not require notarization or witnesses, though state rules and salon policies differ. Use notarization only when required by state law or when clients request an extra notarized record.

What if a client misstates allergies?

Document the client's answers as provided and note your review and any questions asked. If a later reaction occurs, retained intake records, technician notes, and documented patch test results support defense; consistent procedures reduce exposure.

How long should forms be kept?

Maintain consent forms for the active client relationship and a recommended minimum of seven years after termination for liability and insurance purposes. If records include protected health information, follow HIPAA six-year retention rules (45 CFR §164.530(j)).

Can a client withdraw consent later?

Clients can generally withdraw consent, but withdrawal does not retroactively negate services already provided. Document withdrawal in writing and note any required steps; consult state consumer protection rules for specific remedies or refund policies.

What to do after an adverse reaction?

Follow documented emergency procedures, provide medical referral if needed, photograph the area, record the client's account and timing, and preserve the signed consent and patch test results. Prompt documentation aids insurance claims and regulatory inquiries.

Electronic Signature
Templates
Healthcare
Client Consent Form for Eyelash Extensions

Client Consent Form for Eyelash Extensions

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Client Consent: EYELASH EXTENSIONS

Thank you for choosing Blush Aesthetics Studio, We look forward to a long & lengthy lash affair. So, From the start we are completely honest & transparent. Because of the nature of this service There are no refunds given, There are no guarantee of results. For example Lash care & longevity vary from individual to individual. So we recognize that because of the many variables; once lashes are applied and have left the building, we can not give guarantees on the life of your lashes once they leave our hands. If any other lash company tells you otherwise you may want to reconsider.

Full Name:

Telephone / Cell:

Email:

Referred By:

Have you ever had eyelashes extensions before? Yes No

If yes, what type?

_________ If No, we recommend a patch test. Please initial if you are opting out of the advised adhesive patch test.

_________ Please initial that you understand that a patch test does not guarantee that a adverse reaction will not happen.

Do you Perm/Curl or color your eyelashes? Yes No

In any of the above circumstances, have you experienced excessive loss or damage to your eyelashes? Yes No

Have you been using any eyelash conditioner? Yes No

If yes, when was last time you used it?

What brand?

Did you have any allergies or allergic reaction? Yes No

If Yes Please Explain

Is there a medical reason why eyelashes extension may not be suitable for you? Yes No

If Yes Please Explain

IF ANY OF THE FOLLOWING APPLIED TO YOU IN THE PAST 6 MONTHS, PLEASE CHECK:

Allergy to adhesives in Band aid or medical tape? Eye illness or injury? Allergy to surgical glue or nail glue? Seasonal Allergies? Blepharitis (inflamed eyelids)?

DO YOU HAVE:

Hormone imbalance or extreme stress? Yes No

Recent severe illness or major injury? Yes No

Pregnancy or recent childbirth? Yes No

Conditions that contribute to hair and eyelash loss? Yes No

Chemotherapy, blood thinners (anticoagulants) or blood pressure med (beta blockers)? Yes No

Medication prescribed for hair loss, thyroid disease, alopecia, lupus or diabetes? Yes No

If so please describe?

Please list below all medications & illness or conditions you currently have:

CLIENT WAIVER & RELEASE

All Boxes Must Be Initialed. By Doing So You Have Read, Understood And Agree To The Terms.

I authorize Saadia Persad of Persad-Tirone LLC DBA Blush Aesthetics Studio to provide and apply semi-permanent eyelash extensions to my eyelashes. In order to minimize risk of eye injury I understand that it is my responsibility to lie still with closed eyes for the entire eyelash extension procedure or until otherwise directed. I have been fully informed regarding the methods used in the application of semi-permanent eyelash extensions. I understand as part of the procedure eye irritation, eye pain, eye itching, discomfort and in rare cases eye infection may occur I understand these risks and potential complications, and knowingly and voluntarily consent to the application and/ or the removal of semi-permanent eyelash extensions.

If at any time during the eyelash extension procedure I feel uncomfortable, I agree to immediately notify Saadia Persad of Persad-Tirone LLC DBA Blush Aesthetics Studio. She will seek to remedy the problem, including ending the session if deemed prudent. I acknowledge that no guarantees or promises regarding the appearance or longevity of the lash extensions have been made. I hereby certify I have disclosed all conditions regarding my health history, medications and past reactions to products, treatments & medications.

I agree to use only recommended products on my eyelash extensions and Fully understand that careful maintenance is required.

I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the clients natural eyelashes.

I understand and agree that if I experience any previously stated issues with my lashes that I will contact my technician and have the eyelashes removed immediately and consult a physician at my own expense.

I understand that even though the technician may apply and remove the eyelashes properly, that adhesive materials may become dislodged during or after the procedure, which may irritate my eyes or require further follow up care.

I understand and agree to follow the after care instructions provided by my technician. Failure to follow the after care instructions can cause the eyelash extensions to fall out and damage the natural lash.

I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep My eyes closed for duration of 60 - 150 minutes during the procedure. I also understand that I will need to be lying in a reclined position. Any medical conditions that might be aggravated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes.

POST EYELASH EXTENSION

All Boxes Must Be Initialed. By Doing So You Have Read, Understood And Agree To The Terms.

Avoid getting eyelash extensions wet for the first six hours following application.

Avoid steam, saunas, hot tubs, swimming, suntan beds, spray tanning, excessive heat or sweating.

Avoid wearing eye makeup or eye cream.

There are no refunds only repairs or removals. If you have an adverse reaction (please send picture or come in immediately to be seen in person) or if you decide they are not for you, we offer a complimentary removal within 48 hours. After that its $30 removal fee.

Avoid oil based eye makeup and eye cleansing products. I understand oil based products will affect the adhesive and cause my extensions to fall off prematurely. Avoid wearing mascara this will affect the adhesive bond.

Avoid hair conditioner from getting on my extensions when rinsing from hair

Avoid transferring natural oils from my fingers by touching my lashes to avoid adhesive break down

Avoid using eyelash curlers, and tinting or perming my eyelash extensions

Avoid getting facial moisturizer or eye cream on my lash line

I will Brush my lashes with a wand, ideally, when they are wet to keep them in optimal shape.

I will Inform my esthetician about my lash extensions when receiving skin care treatments using acids or steam.

REGARDING LASH SERVICES, I UNDERSTAND AND AGREE TO COMPLY WITH THE FOLLOWING INSTRUCTIONS:

CANCELLATION/RESCHEDULING POLICY: Your scheduled appointment is reserved exclusively for you. If you should need to cancel or reschedule an appointment, please notify us 24 hour in advance. Less than a 24 hour notice will result in a charge of 50% of services reserved. Same day cancellations, same day rescheduling & No shows will result in a charge of 100% of services reserved.

If you are late you may not get the full amount of extensions on but will be charged for the full price of the service.

I agree to not wear makeup to my lash appointments Adhesive used to apply the eyelash extensions may get underneath the contact lens and cause corneal abrasion or scratching. Contact lenses must be removed prior to eyelash extension procedures.

CLIENT WAIVER & RELEASE

All Boxes Must Be Initialed. By Doing So You Have Read, Understood And Agree To The Terms.

I understand the natural growth cycle of an eyelash is sixty to ninety days. Each month approximately 30% of my eyelashes shed and extensions go with them. When one sheds another lash grows in. I understand that I will need touchups every 2-3 weeks to keep my lashes looking optimal. I understand that variables including my natural eyelash cycle and my home care regime will influence the longevity of my eyelash extensions.

I grant permission for my lash stylist to use my before and after photos for marketing purposes or to display examples of my lash stylists work. Before and after photos are a permanent part of the Lash Stylists records. You may opt out of marketing purposes.

I understand the policies Blush Aesthetics Studio are as follows Cancellation/Rescheduling Policy: Your scheduled appointment is reserved exclusively for you. If you should need to cancel or reschedule an appointment, please notify us 24 hour in advance. Less than a 24 hour notice will result in a charge of 50% of services reserved. Same day cancellations, same day rescheduling & No shows will result in a charge of 100% of services reserved.

By signing this client waiver and release agreement, I, the client named below certify that I knowingly and voluntarily release Saadia Persad & Persad-Tirone LLC DBA Blush Aesthetics Studio and its directors, officers, owners, employees, agents and representatives from any and all claims for damages for personal injury arising from the application and use of semi-permanent eyelash extensions, including any damages relating to known or unknown complications which may arise during or following the application process including but not limited to claims for negligence. I further release and hold harmless Saadia Persad & Persad-Tirone DBA Blush Aesthetics Studio from any claims relating to preexisting conditions I have not revealed or changes to those conditions subsequent to the procedure.

This agreement will remain in effect for the procedure and all future procedures conducted by my technician for the entire duration of my time using the services of Saadia Persad of Persad-Tirone LLC DBA Blush Aesthetics Studio I understand that this agreement is binding and that I have read and fully understand all information listed above. I represent that I am over the age of 18 years. If below 18 years of age a parent or guardian must also sign this form.

I agree that if any action is brought to enforce the terms of this agreement, the prevailing party shall be entitled to its costs and reasonable attorneys fees incurred in connection with enforcing this agreement. Any claims arising out of this agreement will be resolved through binding arbitration using the rules of the American Arbitration Association.

I certify that I have read and fully understand this Client Waiver & Release Agreement. I further certify that I have completed the Client Intake and Consent Form accurately and completely to the best of my knowledge, and that I understand the potential complications and risks described. I hereby authorize Saadia Persad & Persad-Tirone LLC DBA Blush Aesthetics Studio to provide and apply semi-permanent eyelash extensions to my natural eyelashes, in accordance with the terms and conditions set.

Esthetician (Printed Name & Signature)

Date

Client Consent: EYELASH EXTENSIONS

You will be required to sign this on the day of your appointment

Client Name (Signature)

Client Name (Printed)

Date

What the Client Consent Form for Eyelash Extensions Is

Client Consent Form for Eyelash Extensions is a written document that records a client's informed consent to receive eyelash extension services, including acknowledgment of procedure steps, possible reactions, aftercare instructions, and cancellation or refund policies. The form documents medical history, allergies, previous adhesive reactions, and current medications that could affect treatment. It establishes expectations for both the technician and the client, records disclosures about risks and maintenance, and creates a dated record of the client's authorization to proceed.

Why a Clear Consent Form Matters

Using a Client Consent Form for Eyelash Extensions reduces liability by documenting informed consent, captures relevant medical and allergy information, and clarifies aftercare responsibilities. It supports client safety, helps technicians follow protocols, and provides a written record useful in disputes or insurance inquiries.

Who Completes and Relies on the Form

Technicians, salon owners, and clients commonly complete this consent form before eyelash extension appointments to document risks and medical disclosures.

Licensed lash technicians who perform the service and need documented consent.
Salon owners for compliance records, staff training, and liability management.
Clients to confirm medical history, allergies, and acceptance of risks and aftercare.

Medical professionals may review entries if complications arise; legal counsel uses the form as evidence in disputed claims.

Step-by-Step: Completing the Form Before Treatment

Follow this step-by-step sequence to complete and retain a Client Consent Form for Eyelash Extensions before service.

01

Collect Health Info: Ask about allergies, medications, and recent eye procedures.
02

Patch Test: Perform adhesive patch test when indicated and note result.
03

Explain Aftercare: Describe cleaning, brushing, and product avoidance instructions.
04

Sign & File: Obtain dated signature, initials on key clauses, and store.

How to Configure the Digital Workflow

Configure the digital workflow to ensure correct field placement, signer authentication, and record retention for consent forms.

Field	Configuration
Signature Field	Required for client; date auto-filled on signature.
Authentication	Email link by default; SMS OTP optional.
Conditional Fields	Show patch test result only if allergies indicated.
Retention Settings	Retain signed record for minimum 7 years; exportable.

Typical Signing Flow and Record Storage

The signing workflow shows how the client completes the form and how records are stored for future reference.

Upload Template: Load consent PDF or create from template.
Place Fields: Add signature, date, initials, and checkbox fields.
Send to Client: Deliver via email or secure link for signing.
Archive Record: Save signed copy and audit trail to file.

Platform Capabilities to Require

Ensure platform supports secure e-signatures, audit trails, and appropriate authentication options for client-facing medical consent forms.

File Formats: PDF and DOCX formats accepted.
Integrations: Works with Google Drive, Microsoft 365.
Mobile Support: Responsive signing on iOS and Android.

Essential Elements of a Professional Consent Form

A professional Client Consent Form for Eyelash Extensions should combine clear risk disclosure, medical screening, aftercare guidance, electronic signing options, secure storage, and version control for compliance.

Risk Disclosure

State common and rare risks of eyelash extensions, including irritation, allergic reaction, and lash damage. Use plain language, quantify likelihood when possible, and include steps clients can take to reduce risk before and after treatment.

Medical Screening

Collect past ocular history, current medications (especially retinoids and blood thinners), contact lens use, and prior adhesive reactions. Require affirmative responses to trigger patch testing and documented technician review of elevated-risk entries.

Aftercare

Provide clear instructions on cleansing, avoiding oil-based products, recommended brushing, and when to return for fill appointments. Explain signs of infection and a contact procedure for complications within 24 to 72 hours.

eSignature

Allow electronic completion with a clear consent disclosure stating right to paper, ability to access records, and method to withdraw consent. Capture signer identity, timestamp, IP, and an audit trail for legal validity under ESIGN and UETA.

Recordkeeping

Store signed forms securely, maintain audit trails, and associate records with client profiles. Ensure encrypted storage, controlled access, and searchable metadata for incident review, insurance claims, and regulatory inquiries.

Versioning

Include form version date, technician initials for any changes, and a clear policy for updating consent after protocol or product changes. Retain prior versions to document informed consent history.

Practical Best Practices for Consistent Intake

Practical tips help ensure accurate intake, consistent client experience, and defensible records for eyelash extension consent.

Use clear, plain-language risk explanations

Write risk descriptions at an accessible reading level, avoid technical jargon, and include concrete examples. State the likelihood and possible severity of reactions where reasonable. Clear language improves client understanding and reduces later disputes.

Require affirmative consent and initials for key items

Ask clients to initial specific clauses such as allergy disclosure, patch testing, and photo consent. Affirmative initials and a dated signature demonstrate that the client reviewed important points and actively agreed, strengthening legal defensibility of the record.

Use standardized templates across staff and locations

Standardized forms reduce omissions, ensure consistent questions, and simplify staff training. Version-controlled templates make audits straightforward and ensure every client receives identical disclosures. Training staff on completing and storing the form avoids inconsistent practices that increase liability.

Keep clear post-treatment follow-up procedures

Document post-care instructions and schedule a follow-up contact window. Encourage clients to report adverse reactions immediately and keep a record of any communications, photographs, and remediation steps. Prompt documentation supports insurance claims and regulatory responses if needed.

Common Pitfalls to Avoid

Failing to obtain a signed, dated consent form before service, leaving the salon exposed to disputes when adverse events occur afterward.
Using ambiguous language about possible reactions or aftercare responsibilities that leaves client expectations unclear and complicates enforcement.
Not recording allergy history, prior lash glue issues, or medications such as isotretinoin that elevate risk of complications during treatment.
Allowing unsigned digital copies or unchecked initials in place of full signatures, which can weaken legal standing if contested.

Consequences of Incomplete or Incorrect Forms

Allergic Reaction: Risk of swelling, infection

Product Liability: Claims over faulty adhesives

Incomplete Disclosure: Missing allergies increases liability

Consent Invalidity: Improper signing may void consent

Regulatory Action: State board complaints or fines

Civil Damages: Potential lawsuits for negligence

eSignature Pricing Comparison for Client Consent Forms

Pricing and plan features for common eSignature vendors to consider when delivering and storing Client Consent Forms for Eyelash Extensions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Practical Examples from Salon and Mobile Practice

Representative scenarios show how consent forms reduce risk and standardize client intake across salon operations.

Boutique Salon

A boutique salon implemented standardized consent forms to document allergies, adhesive brands, and aftercare instructions before every appointment.

Client allergy flagged during intake prevented reaction.
As a result, the salon reduced adverse-event disputes, had clear records for insurance inquiries, and strengthened staff training by referencing completed forms during reviews and remediation.

Mobile Technician

A freelance lash technician used a digital consent form with photo capture and client signature to serve house-call clients.

Digital record simplified follow-up care and product tracing.
The stored signed form and photo evidence enabled the technician to verify pre-service condition, confirm product lot numbers when needed, and provide documentation during an insurance claim or third-party review without delay.

Key Timing Expectations and Review Intervals

Key timing expectations for obtaining, storing, and updating client consent forms are summarized below for salons.

Before Service:

Obtain signed consent at first appointment or before application of extensions.

Patch Test Timing:

Perform 24–48 hours before full application when client history suggests sensitivity.

Record Updates:

Update the form when medical status or medication changes occur.

Retention Start:

Retention begins on signature date; store original signed copy.

Review Interval:

Review consent forms annually or when treatment protocol changes.

Milestones from Intake to Post-Treatment Recording

Milestones show the sequence from intake through follow-up for comprehensive client consent management and recordkeeping.

01

Intake and Disclosure

Collect medical history, allergies, and prior adhesive reactions.

02

Patch Test Period

Schedule and record patch test result before full service.

03

Service Authorization

Client signs consent and acknowledges aftercare and refund policy.

04

Follow-up and Incident

Document follow-up communications and any adverse events for records.

Security and Compliance Considerations

Encryption in transit: TLS 1.2 and 1.3 protocols

Encryption at rest: AES-256 with secure key management

Audit trail: Tamper-evident logs with timestamps and IPs

HIPAA compliance: Business Associate Agreement available

Authentication options: Email, SMS OTP, two-factor options

Access controls: Role-based permissions and SSO support

Typical Signatories and Their Roles

Client

Individual receiving eyelash extensions; provides medical history, discloses allergies and medications, acknowledges risks, and consents to treatment. Accurate answers ensure appropriate adhesive and technique selection and reduce risk of adverse reactions and treatment cancellation.

Technician

Licensed practitioner who reviews the client's form, conducts patch tests if indicated, explains risks and aftercare, documents product brands and adhesive lot numbers, and records consent. The technician's notes support clinical decisions and defend against post-treatment disputes.

Consent Form Compared with a General Liability Waiver

Quick comparison of the Client Consent Form for Eyelash Extensions versus a general liability waiver to clarify scope and enforceability.

Document Type	Consent Form	Liability Waiver
Purpose	medical disclosure and consent	broad risk waiver
Signature Type	dated signature required	dated signature possible
Legal Basis	esign/ueta compliant	esign/ueta compliant
Typical Use	pre-treatment screening	general liability coverage

Frequently Asked Questions About the Consent Form

Answers to frequent questions about using, signing, and storing the Client Consent Form for Eyelash Extensions.

Need help? Contact support

Can this be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure intent, consent, signer attribution, and record retention are met; include consumer disclosure when services are consumer-facing.
Is a notary or witness required?
Typically no. Consent forms for routine eyelash extensions do not require notarization or witnesses, though state rules and salon policies differ. Use notarization only when required by state law or when clients request an extra notarized record.
What if a client misstates allergies?
Document the client's answers as provided and note your review and any questions asked. If a later reaction occurs, retained intake records, technician notes, and documented patch test results support defense; consistent procedures reduce exposure.
How long should forms be kept?
Maintain consent forms for the active client relationship and a recommended minimum of seven years after termination for liability and insurance purposes. If records include protected health information, follow HIPAA six-year retention rules (45 CFR §164.530(j)).
Can a client withdraw consent later?
Clients can generally withdraw consent, but withdrawal does not retroactively negate services already provided. Document withdrawal in writing and note any required steps; consult state consumer protection rules for specific remedies or refund policies.
What to do after an adverse reaction?
Follow documented emergency procedures, provide medical referral if needed, photograph the area, record the client's account and timing, and preserve the signed consent and patch test results. Prompt documentation aids insurance claims and regulatory inquiries.

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