New Client Profile

Please submit before you arrive.

Appointment Date *

Appointment Date

MM

DD

YYYY

Name *

Name

First Name

Last Name

Email Address *

Phone *

Phone

(###)

###

####

Date of birth (Free goodies on your special day!) *

Date of birth (Free goodies on your special day!)

MM

DD

YYYY

Instagram username (optional)

@

How would you describe your hair quality? *

Is this your first time having a lash lift procedure? *

How frequent do you use a manual lash curler? *

What degree of curl do you want? *

Do you wear contacts? (If yes, please bring your glasses.) *

Are you able to keep your eyes closed and lie still for 1.5 hours or longer? *

Please indicate any of the following that might apply to you:

Sensitive, watery eyes

Sensitive skin

Allergies to latex, adhesives on band-aids

Allergies/sensitives to hair dyes, chemicals or colorants

Allergies to collagen, shellfish or hydrogels

Eye surgery, eyebrow/eyeliner tattoo, eyelid/bag lift, or injectables in the last 2-4 weeks

Use of Retinoid for skin treatment

Any other allergies I should know of

Recent severe illness

Any concerns to address?

Client Consent Form

Please submit before the procedure.

Although every precaution will be taken to ensure your safety and well-being before, during and after your lash lift procedure, please be aware of the following information and possible risks. PLEASE CHECK BOX TO CONFIRM *

I understand that if I cancel my appointment within 24 hours of my scheduled time, I will be charged 50% of my scheduled services. If I "no-showed" for my appointment, I will be charged 100% of my scheduled appointment. I understand that lash lift/perming services have some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging and burning, blurry vision and potential blindness should the perming solutions enter the eye or should an allergic reaction occur. I understand that some irritation, itching or burning may occur on the skin if the perming solutions come into contact with it. I understand that if the perming solutions come into contact with my eye, my eye will be flushed with water and may be required to see medical attention immediately. I understand that I will not get my lashes wet for the first 24 hours, avoiding any extreme heat such as sauna and steam for the first 48 hours. I understand that although the results shown to last anywhere from 6-8 weeks. It will be different with each individual as not everyone's hair growth and natural hair shedding cycle is the same. I understand while every attempt will be made to provide me with the lift/curl I have chosen, my final result may not be what I initially envisiobed. I understand and agree to the care instructions proved by Lash Lift By Toni professional for the use and care of my permed lashes. I realized and accept the consequences of failure to adhere to these instructions my cause lashes to not stay permed as long as told. I understand and agree to that NO WATER CAN COME TO CONTACT WITH THE EYE AREA FOR 24 HOURS AFTER APPLICATION. I agree and consent to having my eyes closed and covered for the duration of the 60-75 min procedure. I understand that it is imperative that I disclose all of the information requested in the New Client Profile. I have cited all conditions and circumstances regarding my health history, medication being taken and any past reactions to productions or medications. I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure. I consent to "before and after" photographs for the purpose of documentation and potential promotional/advertising purposes. This agreement will remain in effect for this procedure and all future procedures conducted by Lash Lift By Toni. I have read and fully understand all information in this agreement. I am over 18 years of age and consent to the agreement and to proceed. I understand that if I have any concerns, I will address these with my lash technician, I give permission to Lash Lift By Toni and its lash specialist, to perform the lash extension procedure we have discussed, and will hold him/her and Lash Lift By Toni harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand Lash Lift By Toni and my technician will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult Lash Lift By Toni immediately. I agree that this constitutes full disclosure, and that it will supersedes any previous verbal and written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold Lash Lift By Toni responsible for any of any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

Name *

Name

First Name

Last Name

Electronic signature *

Date *

Date

MM

DD

YYYY

Appointment Date *

Appointment Date

MM

DD

YYYY

Appointment Prep

Yay! Get ready!
Let's get to know each other a bit before your appointment.

New Client Profile

Client Consent Form

Book an
Appointment

SErviceS
CONTACT
FAQ

1128 Mission St
South Pasadena
CA 91030

also available

Los Angeles, California

Los Angeles, California

Appointment Prep

Yay! Get ready!Let's get to know each other a bit before your appointment.

New Client Profile

Client Consent Form

Yay! Get ready!
Let's get to know each other a bit before your appointment.