Consent Forms

Review each treatment consent form here. Logged-in clients can update their saved answers; guests can print any form and log in to submit it online.

Brow Henna Consent Form Brow Lamination Consent Form Brow Wax & Tint Consent Form Dermaplaning Consent Form Lash Extensions Consent Form Lash Lift Consent Form Microneedling Consent Form

Lash Extensions Consent Form

Version 2026.03.17
Register or log in to complete and submit this form online. Guests can still print this page for offline use.

Client Information

Health History

Have you had eyelash extensions in the past?
Do you have any allergies?
Do you wear glasses?
Do you wear contact lenses?
Do you currently have any eye illnesses/conditions?
Do you use any eye drops or medication?
If so, please list
Do you have an allergy to adhesives, Band-Aids, or medical tape?
Do you have an allergy to surgical glue or nail glue?
Do you have seasonal allergies?
Do you have an allergy to glycerin?
Do you have an eye illness, injury, or blepharitis (inflamed eyelids)?
Do you have permanent eye makeup?
Have you had an eye lift?
Are you taking any medications that can cause temporary hair loss?
Have you had a major surgery within the last 120 days?

Consent & Liability

I agree to the following follow-up and maintenance instructions:

  • Do not use waterproof mascara.
  • Do not use oil-based products around the eye area.
  • Do not allow water to come into contact with the eye area for 24 hours after application.
  • Do not tint or perm eyelash extensions.
  • Do not pull or rub the eyelash extensions.
  • If any kind of eye drops are necessary, take extra care to prevent moisture from coming into contact with the eyelash extensions.
Client Name (Print)
Date
Client Signature

I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by Aliya's Beauty.

I understand and agree to the after-care instructions given by Aliya's Beauty, and I understand that any unexpected circumstances resulting from not following these instructions are at my own risk.

I understand that on rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.

I understand that because of the natural lash cycle and normal wear and tear, I will need to maintain my extensions with touch-up appointments, usually recommended every 2 to 3 weeks, to keep them full.

Client Name (Print)
Date
Client Signature
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