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Lash Extension Consent Form

Have you had lash extensions before?
Do you wear contact lenses?
Do you wear glasses?
Do you have acrylic allergy?
Do you have a latex allergy?
Have you had surgery around the eye area in the last 6 months?
Allergies to adhesive band aid or medical tape?
Yes
No
Allergies to surgical glue or nail glue?
Yes
No
Seasonal allergies?
Yes
No
Allergy to glycerin?
Yes
No
Eye illness or injury?
Yes
No
Blepharitis (inflamed eyelid)?
Yes
No
I hereby consent and authorize Dariana Torres to perform the lash application
Yes
No
I hereby consent and authorize Dariana Torres to take pictures and videos for educational purposes and to post on social media.
Yes
No
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