Lash Extension Client Health & Consent Screening

Before your lash extension appointment, we need a few minutes of your time to collect health information and your informed consent. This keeps you safe and helps your technician plan your service. About 7 minutes.

Please read the following before continuing.

Do any of the following apply to you?

• Known allergy to latex or adhesives
• Sensitive or easily irritated skin around the eyes
• Eye allergies (seasonal or chronic)
• Recent eye surgery or eye infection (within 6 months)
• Currently pregnant or breastfeeding

Have you ever had a reaction to lash extensions, lash glue, or eye makeup products?

• Never had lash extensions before
• Yes, I had a reaction
• No, never reacted
• Not sure

Please list any medications, eye drops, or supplements you currently use that could affect your eyes or skin (for example, Latisse, retinoids, blood thinners). Type 'None' if this doesn't apply.

Do you currently wear contact lenses?

• Yes, daily
• Yes, occasionally
• No

How clear is your understanding of the aftercare instructions (cleaning, avoiding oil-based products, refill timing)?

Please highlight any part of these aftercare instructions you'd like your technician to explain further.

Avoid getting your lash extensions wet or steamy for the first 24 to 48 hours. Cleanse them daily with an oil-free lash cleanser. Avoid oil-based makeup removers, mascara, and eyelash curlers. Do not…

If the client disclosed any allergy, sensitivity, prior reaction, medication, or contact lens use, probe for specifics: severity, how long ago, and whether a doctor or previous technician advised against or modified lash services for them. If their aftercare understanding rating was 3 or below, walk through the specific instruction they're unsure about (cleaning routine, product restrictions, or refill timing) until they can restate it in their own words. Flag clearly in your summary if anything disclosed suggests the service should be postponed or modified.

Please sign below to confirm the health information you provided is accurate and that you consent to receiving lash extension services today.

One last optional question, then you're all set.

What is your age range? (Optional — helps us track service safety trends across age groups.)

• Under 18
• 18-24
• 25-34
• 35-44
• 45-54
• 55-64
• 65+
• Prefer not to say

Thank you! Your consent and health information will be kept on file with your appointment record and shared only with your technician to help them provide safe, personalized service.