TemplatesLash extension
lash extension consent form
Lash work happens on a closed eye, millimetres from the cornea, with a fast-curing adhesive.
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- screening questions
- 9screening questions
- stop the appointment
- 5stop the appointment
- minutes to set up
- 10minutes to set up
- a month to start
- $8a month to start
Lash extension consent
Full name
Date of birth
Email
Phone
Have you ever reacted to lash glue, eyelash extensions or cyanoacrylate?
YesNo
Adhesive reaction history
Why this form, specifically
It stores the patch test with a date and a time you can produce two years later, which is the specific thing your policy conditions cover on.
Look before you download
The whole document, before you give us anything
Lash extension consent
Your details
Full name
Date of birth
This is where your aftercare instructions go.
Phone
Health questions
Have you ever reacted to lash glue, eyelash extensions or cyanoacrylate?
Have you had a patch test at least 48 hours ago?
Do you have any eye condition, infection or recent eye surgery?
This is the form you get
Not a sample, not a preview of a preview. Every question below is in your account ten minutes after you sign up, with the flags already set and the aftercare email already written.
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- No card needed
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The 9 answers that should stop you
Lash work happens on a closed eye, millimetres from the cornea, with a fast-curing adhesive. Almost every serious lash claim is an allergy or a chemical irritation, and both are screenable in advance. There is no other treatment in this trade where the form does so much of the safety work.
Do not treat
5WhyCyanoacrylate adhesives sensitise on repeated exposure. Once a client is sensitised, the next exposure is usually worse and faster, not milder.
What goes wrong if you treat anywaySwollen, weeping lids, sometimes closing the eye entirely, and in a minority of cases an emergency department visit. This is the claim that costs a lash tech their insurance.
What to doDo not apply. A previous mild reaction is not permission to try again with a 'sensitive' glue - sensitisation does not reverse.
The question that catches itHave you ever reacted to lash glue, eyelash extensions or cyanoacrylate?
WhyA delayed hypersensitivity reaction takes 24 to 48 hours to appear. A test done on the day tells you nothing.
What goes wrong if you treat anywayBeyond the client's reaction: most professional lash policies require a documented patch test, and an undocumented one is a declined claim.
What to doPatch test 48 hours ahead, every new client, and re-test after a long gap or a product change. Store the record with a timestamp, because 'we did one' is not evidence.
The question that catches itHave you had a patch test at least 48 hours ago?
WhyThe lid margin is already inflamed and colonised. Extensions trap debris at exactly the point that needs to be kept clean.
What goes wrong if you treat anywayThe infection worsens and spreads, retention is poor, and the client blames the lashes.
What to doPostpone until it is fully resolved and refer to a pharmacist or GP. Blepharitis in particular needs managing before any lash work is sensible.
The question that catches itDo you have any eye condition, infection or recent eye surgery?
WhyPost-surgical eyes are dry, sensitive, and often still on a drop regime that will disturb adhesive cure.
What goes wrong if you treat anywayIrritation, very poor retention, and a client who has spent money twice.
What to doWait until the surgeon has signed them off, usually three months. Ask for that specifically.
The question that catches itDo you have any eye condition, infection or recent eye surgery?
WhyA lift restructures the disulphide bonds in the lash. The lash is porous and the curl fights the extension's line.
What goes wrong if you treat anywayExtensions that will not sit straight and fall within days.
What to doWait two weeks minimum, and set the expectation that retention will still be below normal.
The question that catches itHave you had a lash lift or perm in the last 2 weeks?
Proceed with caution
3WhyThere must be a healthy natural lash to bond to. Sparse or fragile lashes cannot carry weight, and pulling behaviour will strip natural lashes along with extensions.
What goes wrong if you treat anywayPermanent damage to what is left of the natural lash line.
What to doHandle with obvious care. Light, short extensions only, or decline kindly. Clients mid-chemotherapy should have their oncology team's view first.
The question that catches itHave you had any lash loss, thinning or lash-pulling?
WhyNo evidence that adhesive fumes reach the baby, but hormonal shifts change the lash growth cycle, and lying flat on the back for two hours is uncomfortable and, late on, inadvisable.
What goes wrong if you treat anywayPoor retention that reads as bad work, and a physically miserable appointment in the third trimester.
What to doTreat, with the client propped rather than flat, in shorter sessions, and with retention expectations set honestly in advance. Ventilate well.
The question that catches itAre you pregnant or breastfeeding?
WhyProstaglandin analogues change the lash growth cycle and are associated with lid irritation and pigmentation.
What goes wrong if you treat anywayUnpredictable shedding, irritation that gets attributed to the adhesive, and disappointing retention.
What to doTreat, but document it and set expectations. Ask them to pause a cosmetic serum, never a prescribed drop.
The question that catches itDo you use any eye drops or lash growth serum?
Safe to proceed
1WhyNot a contraindication. Lenses simply must come out before the eye is taped closed for two hours.
What goes wrong if you treat anywayLeft in, the client ends the appointment with dry, gritty, irritated eyes and blames the glue.
What to doAsk them to remove lenses before you start and bring a case. Say it in the booking confirmation, not on arrival.
The question that catches itDo you wear contact lenses?
What you actually get
Nobody buys a consent form
They buy the fifteen minutes back at the start of an appointment. They buy the phone call they did not have to make, because the contraindication turned up two days early instead of two minutes late. They buy an insurer who pays out, because the patch test has a timestamp rather than a memory attached to it.
The form is the mechanism. What you are actually buying is the record it leaves behind.
That is the whole argument, and it is why the questions matter more than the software. A blank form builder hands you a canvas and calls it flexibility. This hands you the nine questions that a waxing client should be asked, in the wording that gets an honest answer, with the risky one already flagged in red.
What this saves you
Not what the form contains - what it gives you back. Every number below is arithmetic you can check on the calculator further down the page.
A defensible claim
instead of a disputed memory
Most professional policies in these trades condition cover on documented screening, and a patch test you can describe is not a patch test you can produce. A timestamped record is the difference between a claim your insurer defends and one they decline.
4 seconds
from signature to aftercare email
The aftercare for their treatment lands in their inbox before they have left the chair, written for that service and editable in your words. Clients who follow aftercare heal better, complain less and rebook more - and you did nothing.
12 hours
a year, back in your chair
A new client filling in a paper form in your treatment room costs ten to fifteen minutes of an appointment they already paid for. Send it with the booking confirmation and that time goes back into treating, at roughly twelve hours a year on twenty clients a week.
Seconds
to find any client's form
The reason to leave paper is not the signing, it is the finding. When a health inspector or a solicitor asks for one specific record from eighteen months ago, you search a name instead of an afternoon.
Same week. One thing changed.
The left-hand column is most studios today. The right-hand one is the same week with the form sent at booking instead of handed over on arrival.
- You patch test, but the record is a note in your phone
- Set seven, and her lids swell overnight
- The insurer asks for the patch test record
- You have one from two years ago, on paper, in a box
Nothing here is negligent. It is just undocumented.
- Every patch test is dated, timed and stored against her name
- The system flagged that she was due a re-test after your glue change
- Set seven happens on a client you tested last week
- If it goes wrong anyway, you can produce the whole history in seconds
Same treatments, same clients, same you. Different record.
Contraindication checker
Can you treat a client who...?
Pick a treatment and a condition. The answer comes with the reason behind it, and the form question that catches it.
Pick a condition
Every answer here is the same rule set that ships inside the product's forms.
Lash work happens on a closed eye, millimetres from the cornea, using a fast-curing adhesive. Almost every serious lash claim is an allergy or a chemical burn, and both are screenable.
Lash extension
What goes wrong without it
The claim is always the same shape.
A client has had extensions six times over two years with no problem. At the seventh appointment her lids swell within hours, close by morning, and she is in an urgent care clinic by lunchtime. This is not a mistake - cyanoacrylate sensitises on repeated exposure, and the seventh set is exactly when it shows up. The technician's insurer asks for the patch test record. There is one for the first appointment, on paper, two years ago, in a box. There is nothing for the last three sets because she was a regular and it felt unnecessary. The claim is declined on the policy condition, not on the clinical facts, and the technician pays personally.
What a lash extensions consent form has to cover
The actual field list, and why each group is on this particular form.
Identity and contact
- Full name
- Date of birth
- Phone
- Emergency contact
The emergency contact is not padding on a lash form. A client lies flat with her eyes taped closed for two hours, and the rare adhesive reaction that closes an eye happens to someone who cannot see to call anyone.
The patch test
- Patch test completed
- Date and time of the patch test
- Adhesive and product used for the test
- Result observed at 48 hours
- Who performed it
This group is the most important thing on the page and the reason to stop using paper. A patch test that happened is worth nothing; a patch test that happened, with a recorded date and time you can produce, is what your policy actually requires.
Allergy and eye history
- Previous reaction to lash glue, extensions or cyanoacrylate
- Conjunctivitis, blepharitis, stye or eye infection
- Dry eye or eye surgery in the last 3 months
- Contact lens wearer
- Glaucoma drops or prostaglandin lash serum
- Lash loss, alopecia or lash pulling
- Recent lash lift or perm
The lash serum question is the newest one and the one most forms are missing. Prostaglandin analogues change the growth cycle, and the retention problem they cause gets blamed on the adhesive every time.
Expectations and consent
- Infill schedule and what happens without it
- Retention expectations
- Aftercare: no water 24 hours, no oil, no mechanical curlers
- Consent statement and initials
- Photo and social media permission
- Signature with timestamp
Retention expectations belong on the consent form rather than in conversation, because 'they fell out too fast' is the most common complaint in lash work and it is almost always a shedding-cycle misunderstanding.
Is a digital signature legally valid?
Exact time signed
IP address
Device and browser
The exact form they saw
Yes - the US ESIGN Act and the state UETA adoptions give it the same legal effect as ink. What makes it hold up is the evidence stored beside it, and a paper form in a drawer carries none of this.
Sign with your fingerDraw a signature with your mouse or trackpad
Where you stand legally
Lash extension application requires a cosmetology or esthetics licence in most US states, and a handful license lash technicians specifically. The regulatory attention here tends to fall on sanitation and on adhesive handling rather than on consent - but the insurance position is where the form earns its place, and it is unusually specific. Professional lash policies commonly condition cover on a documented patch test performed at least 24 to 48 hours before the first application, and on re-testing after a product change or a long gap. 'We always patch test' is not documentation. A record showing the date, the time, the product and the result is, and it is the difference between a defended claim and a declined one. The second point is scope: adhesive removal, treatment of an irritated eye, and any advice about an eye condition are outside a lash technician's remit, and the correct response to an inflamed lid is referral rather than a gentler glue. Check your own board and your own policy wording; this is not legal advice.
Paper, PDF or digital?
Paper
Fine when you are small
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Emailed PDF
Worst of both
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Digital
Earns its place at scale
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Three clients a week? Print it and staple it in a binder. That is genuinely fine, and software would be an expense with no return. Digital earns its place around ten to fifteen clients a week, when finding one form again matters more than the minutes it took to file it.
Questions people actually ask
No statute names one specifically, but your insurance almost certainly conditions cover on documented contraindication screening and a documented patch test. In practical terms that makes the form a requirement, just one written in a policy schedule rather than a state code.
Your form is written. Come and get it.
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General guidance for professionals, not legal or medical advice. Check the rules that apply where you work.