Is an electronic signature valid?

Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states if intent, consent, attribution, and retention are met.

Do I need to notarize the form?

Not typically. Routine cosmetic consent forms rarely require notarization; confirm only if a state board or specific business policy mandates it.

How long must I keep signed consents?

Retain signed consents for at least three years after service; retain six years if HIPAA-protected records apply (45 CFR §164.530(j)).

What happens if a client has an allergic reaction?

Document the reaction, product lot numbers, and follow clinic incident procedures. Preserve the signed consent and product details for potential insurer or regulatory review.

Can minors provide consent?

Minors generally require parental or guardian consent. Verify state law and clinic policy before providing treatment to underage clients.

How to verify signer identity online?

Use email verification, SMS code, or optional multi-factor identity checks. More robust authentication reduces dispute risk and improves evidentiary value.

Electronic Signature
Templates
Healthcare
Eyelash Extensions Agreement and Consent Form

Eyelash Extensions Agreement and Consent Form

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Eyelash Extensions Agreement and Consent Form

Full Name:

Telephone (Cell):

Email:

Referred by:

Initial

I understand that this procedure requires single synthetic eyelashes to be glued to my own natural eyelashes.

I understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, until my eyelash technician addresses me to open my eyes.

I understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if I open my eyes.

I agree to disclose any allergies that I may have to latex, surgical tapes, cyanoacrylate, Vaseline, etc.

I understand that I am required to follow the eyelash extension care sheet (attached hereto) in order to maintain the life of these extensions.

I agree that by reading and signing this consent form, I release Shiori Kitazono and Fabulous Skin & Lash from any claims or damages of any nature.

I agree that I read and fully understand this entire consent form.

I am of sound mind and fully capable of executing this waiver for myself.

I give Shiori Kitazono and Fabulous Skin & Lash permission to show my before and after photos of eyelashes to other potential clients. Yes or No

I have read and completed the Eyelash Extensions Intake & Consent form in its entirety, and have answered everything to the best of my ability. I have been informed of potentially harmful or negative side effects that may be caused by the application and/or removal of Eyelash Extensions.

I confirm and agree that I wish to engage the services of Shiori Kitazono and Fabulous Skin & Lash to apply eyelash extensions.

Print Your Name:

Signature:

Date:

Eyelash Extension After care

Eyelash extensions are not for everyone. This is a very high maintenance beauty treatment. It requires very gentle care in order for the lashes to last long and stay in good condition. Once the lashes are attached you must not rub or pull on them. You must not wear any mascara or use Eyelash curlers. You should read and understand all the information listed below, and sign the form before you get this service done. (initial)

What are Eyelash Extensions?
Eyelash Extensions are individual Synthetic material. They are attached to your Eyelash individually not to the skin. Each synthetic lash is attached to an eyelash. It is a very enhancing beauty service and you DO NOT need to use any Mascara while wearing these Eyelash extensions. It is a very careful and intense service which requires skill and precision. Once applied these lashes are so natural looking it is difficult to tell even up close that you have extensions on. Size availability ranges from short to long. (initial)

How long do the Eyelashes last?
It is an individual process. We lose one Eyelash almost everyday. We also grow a new lash to replace the one that fell out. These Lashes can stay on up to 2 full Months with proper care and maintenance. However, factors such as eyelash growth, lifestyle and general after care will affect how long the lashes last. Please do not attempt to remove any lashes on your own, seek professional help from your technician. WE WILL NOT BE HELD LIABLE FOR ANY DAMAGE THAT YOU MAY CAUSE BY TRYING TO REMOVE THE EYELASH EXTENSIONS ON YOUR OWN.

Do the False Eyelashes damage my natural Eyelashes?
No, not at all! The Lash adhesive is formulated to create a solid bond, specifically for human lashes. The adhesive dries very soft on the lashes, allowing the lashes to stay flexible and bouncy just like your own lashes.

Before Your Appointment
What you should do before your Eyelash Extension appointment. Remove all eye makeup and clean your lashes with mild, oil free cleanser. Do not use oil based makeup removers to clean your lashes prior to the application. Do not put on any mascara. We don’t want to spend time cleaning your lashes. We’d rather spend time working on perfecting your lashes. If you are a contact lens wearer, please remove contact lenses and wear glasses to your appointment, or bring a lens case and remove them when you arrive at your appointment. Plan to set aside 1 to 2.5 hours for your appointment. Some of our clients fall asleep during the procedure. (initial)

1. Do not perm or Tint lashes before or after lash extension application.

2. Do not use a regular Eyelash curler.

3. Do not rub your eyes or lashes when washing your face. Clean around the Eyes with a wash cloth.

4. Do not pull your lash extensions, as it will take out your own lash as well.

5. Do not go in a Sauna while wearing Eyelash extensions.

6. Do not use Mascara.

7. Do not try to remove the Extensions on your own.

8. Do not cut the Extensions (you may cut your own lashes).

9. Clean your eye make up without touching the Extensions.

10. Remember to come in for touch ups.

What happens if a lash should loosen or become dislodged?
Do not pull on the lash. Please contact your Technician to make an appointment to have them removed or replaced, to avoid damage to your natural lash. As your natural lashes fall out due to the growth cycle, you will need refills when new lashes grow. At first you may find you need a refill every 2 weeks. As you become accustomed to the extensions and with a little practice maintaining the lashes, the time between refills can be extended to 3-4 weeks. (initial)

What the Eyelash Extensions Agreement and Consent Form Covers

The Eyelash Extensions Agreement and Consent Form documents the service details, client medical and allergy disclosures, procedural risks, aftercare instructions, and the client's informed consent before eyelash extension application. It typically includes client identification, stylist and salon information, product types or adhesives to be used, and any relevant contraindications. The form creates a record that the technician explained risks and aftercare, and that the client consented to proceed — reducing misunderstandings and providing evidence in the event of a dispute or an adverse reaction.

Why a Written Consent Form Matters for Eyelash Services

A clear, signed consent form documents the client's disclosures and informed agreement to treatment, helps meet local licensing expectations, supports safe client care, and provides a dated record if follow-up or liability questions arise.

Who Completes This Form and Why It Matters

Salon owners, licensed lash technicians, and clients use the Eyelash Extensions Agreement and Consent Form to document treatment specifics and informed consent before service.

Licensed lash technician: Confirms product selection, documents client disclosures, and records consent to proceed.
Salon owner / manager: Maintains compliance records and incident documentation for client safety and business risk control.
Client / patient: Records allergies, recent eye procedures, and acknowledges aftercare instructions to reduce adverse outcomes.

Keeping the signed form on file supports client care, risk management, and, where applicable, compliance with state cosmetology or health board requirements.

Step-by-step: Complete the Consent Form Before Treatment

Follow this concise sequence to ensure the form is complete, accurate, and retained appropriately before eyelash extension services begin.

01

Intake: Collect full name, contact, and emergency information.
02

Medical Disclosures: Record allergies, eye conditions, medications, recent surgeries.
03

Service Details: Specify extension type, lash curl, adhesive, and expected duration.
04

Signature: Client signs and dates, technician countersigns and records the date.

Configuring the Digital Workflow for Online Consent

Set up a digital workflow that captures client data, verifies identity, and records an auditable signature trail before the appointment.

Field	Configuration
Name Field	Required; exact-match verification enabled
Date Field	MM/DD/YYYY format; auto-fill allowed
Medical Disclosure	Textarea; required checkbox for accuracy
Signature	Single signer signature; capture timestamp

Technical Considerations for eSigning and Storage

Choose a platform that supports secure signing, audit trails, and optional advanced authentication for higher-risk procedures.

File Formats: PDF and DOCX supported
Authentication: Email or SMS code options
Audit Trail: IP, timestamp, action log

Store signed records in encrypted storage with access controls; ensure retention aligns with applicable healthcare or business record rules and that export options exist for audits or regulatory requests.

Typical Online Consent Flow for an Eyelash Appointment

A streamlined online flow reduces front-desk time while preserving a complete record of consent and disclosures.

Upload: Sender uploads the consent form template to the eSignature platform.
Prepare: Place name, medical, and signature fields where clients must complete.
Send: Client receives an email or text link to complete the form before arrival.
Store: Signed copy and audit trail are stored and available for download.

Essential Elements to Include in a Professional Consent Form

A robust consent form balances clinical detail, clear risk disclosure, and simple aftercare instructions so clients understand treatment and technicians have documented consent.

Client Identification

Full legal name, date of birth, and contact information establish client identity and allow follow-up in case of adverse reaction or scheduling changes.

Medical Disclosures

A concise checklist for allergies, medications, recent surgeries, eye infections, pregnancy, and contact lens use helps identify contraindications before adhesive application.

Procedure Details

Specify extension length, curl type, adhesive brand, and estimated application time so expectations are clear and product tracking is possible if needed.

Risk and Side Effects

Clear, plain-language descriptions of common reactions, possible infections, and adhesive sensitivities help ensure informed consent and set realistic expectations.

Aftercare Instructions

Provide actionable steps for cleaning, water exposure, makeup use, and signs that require contacting the salon or a medical professional.

Release and Signature

A statement confirming the client understands risks, followed by dated signature lines for client and technician to confirm consent and completion of disclosures.

Data and Security Details to Record

Client ID: Name and DOB

Contact: Phone and email

Medical Notes: Allergies and meds

Product Info: Adhesive brand

Signature Data: Timestamp and method

Retention Tag: Record retention rule

Common Legal and Business Risks If the Form Is Incomplete

Service Disputes: Increased liability risk

Regulatory Noncompliance: License board sanctions

Insurance Denial: Claims may be rejected

Medical Harm: Unreported allergies escalate risk

Record Gaps: Missing evidence in incidents

Data Breach: Exposure of PHI possible

Frequent Mistakes to Avoid When Preparing the Form

Using vague product descriptions such as 'lash glue' instead of brand and batch makes tracing reactions difficult and weakens client protection.
Failing to record medical disclosures or relying on verbal notes increases liability if an allergic reaction or complication occurs after treatment.
Accepting initials in place of a full signature or missing the signature date can undermine enforceability and lead to disputes.
Inadequate storage or retention practices that fail to protect signed forms and audit trails raise regulatory and privacy risks.

Timing Expectations and Important Deadlines

Set clear timing rules so consent is valid and available when the service occurs; include any required pre-treatment waiting periods in clinic policy.

Before Service:

Obtain signed consent before starting the eyelash application

Pre-Procedure Wait:

If a mandatory review period exists, document the required waiting time

Rescheduling:

Update consent if service details materially change before rebooking

Adverse Event Reporting:

Report serious reactions promptly per clinic policy and insurer requirements

Record Access:

Provide copies to client on request within reasonable company timelines

Key Process Milestones from Intake to Aftercare

These milestones outline the main stages that must be documented and the typical sequence for a single treatment episode.

01

Client Intake

Collect identification, contact, and medical disclosures at first contact

02

Consultation

Discuss risks, expected outcomes, and alternative options with the client

03

Consent Signing

Obtain dated signature and technician countersignature prior to treatment

04

Aftercare Follow-up

Record aftercare instructions and any follow-up communications or reported problems

eSignature Pricing Comparison for Managing Consent Forms

Basic pricing and feature availability for common eSignature providers. signNow appears first; choose based on volume, compliance needs, and required features.

	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 trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
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	Varies	Varies

Common Questions About the Eyelash Extensions Agreement and Consent Form

Answers to frequent questions on completion, signatures, storage, and electronic acceptance for consent forms used in lash services.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states if intent, consent, attribution, and retention are met.
Do I need to notarize the form?
Not typically. Routine cosmetic consent forms rarely require notarization; confirm only if a state board or specific business policy mandates it.
How long must I keep signed consents?
Retain signed consents for at least three years after service; retain six years if HIPAA-protected records apply (45 CFR §164.530(j)).
What happens if a client has an allergic reaction?
Document the reaction, product lot numbers, and follow clinic incident procedures. Preserve the signed consent and product details for potential insurer or regulatory review.
Can minors provide consent?
Minors generally require parental or guardian consent. Verify state law and clinic policy before providing treatment to underage clients.
How to verify signer identity online?
Use email verification, SMS code, or optional multi-factor identity checks. More robust authentication reduces dispute risk and improves evidentiary value.

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