The Beauty Bar
56475 Main Road
2nd Floor
Southold, NY 11971
(631)765-9600
Eyelash Extension Agreement and Consent
Name: ______________________________________________
Date: _______________________________________________
Best Contact Number: _______________________________
Address: ____________________________________________
City: _________________ State: ____________ Zip:_________
Email Address: _______________________________________
Referred by: _________________________________________
I understand that this procedure requires single synthetic eyelashes to be glued
to my own natural eyelashes. I understand that it is my responsibility to keep my
eyes closed and still during the entire procedure, until my eyelash technician
addresses me to open my eyes. I understand that some risks of this procedure
may be but are not limited to eye redness, swelling of eyelids and irritation. The
fumes of the adhesive may cause my eyes to water. I agree to disclose any
allergies that I may have to my lash technician. I understand I am required to
follow the eyelash extension care sheet in order to maintain the life of these
extensions. I agree that reading and signing this consent form, I release Allison
Rappa of The Beauty Bar from any claims or damages of any nature. I agree
that I read and fully understand this entire consent form. I am of sound mind and
fully capable of executing this waver for myself. The undersigned confirms
receiving, reading and reviewing with the technician the attached consent
form. I confirm and agree that I wish to engage the services of The Beauty Bar to
apply eyelash extensions.
Client Signature: _____________________________________________
Date: ______________________________
Eyelash extensions are not for everyone. This is a high maintenance beauty
treatment that requires gentle care for the lashes to remain in optimal condition
and be long lasting. Once the lashes are attached, you must not rub or pull on
them. You must not wear mascara other than one your technician may
recommend. You must not use eyelash curlers. Please read and understand all
of the information listed below and sign the consent prior to having this service
performed.
Initials: _______________
What you should do prior to your eyelash extension appointment
Do not wear any mascara and clean your lashes using a mild, oil free cleanser.
Do not use oil based makeup remover prior to the eyelash extension application.
Plan to set aside 1.5 – 2 hours for your initial appointment.
What are eyelash extensions?
Eyelash extensions are individual synthetic, Mink or Silk eyelashes. They are
attached one by one to each of your individual natural lashes, not to the skin.
This service is beauty enhancing and completely eliminates the need to wear
mascara. It is a meticulous service, which requires the skill and precision of your
certified lash technician. Once the eyelash extensions are applied, they are
extremely natural looking. Size availability ranges from short to long, thin to thick,
which will be decided and agreed upon between you and your eyelash
technician to best suit your expectations.
How long will my eyelash extensions last if I follow the proper care instructions?
In some cases, eyelash extensions can last for up to 4 weeks. However, it is
recommended to get a touch-up after 2 weeks. Like all hair, there are 3 phases
to the eyelash growth cycle. There are lashes in each phase at all times,
therefore, some will be lost within a couple of weeks, while others can last much
longer as part of the natural cycle.
How much to eyelash extensions cost and how long is the appointment?
The initial cost for the application is $200 for Novalash, $250 for Mink and $300 for
Silk. The initial application will take approximately 90 minutes. Your 2 week
maintenance appointment “Fill” will take an hour and will cost $75 for Novalash,
$85 for Mink and $90 for Silk. If you exceed 2 weeks please expect an additional
$25 to be added onto the cost of the fill. After 3 weeks without a maintenance
appointment, you will be in need of another full set application, which will take
90 minutes and will put the cost back up to the initial full set price (unless
otherwise determined by your lash technician)
Do eyelash extensions damage my natural lashes?
No. When extensions are applied correctly, they will not harm your natural
lashes. Each lash extension is adhered to one single natural lash, the extension
will grow out naturally as your own lash matures. The adhesive is formulated to
create a solid bond, specifically for human lashes. The adhesive dries very soft
on the lashes, allowing them to stay flexible just like your own lashes.
I have read the above information and agree to continue with the eyelash
extension application service
Initial: _______________________
Home care for your eyelash extensions, please review and follow these
recommendations
-Do not perm or tint your lashes
-Do not use an eyelash curler
-Do not rub your lashes while washing your face, gently cleanse your face with
an oil free mild cleanser with a soft cloth or Q-tip
-Do not pull on your lashes, as you are likely to pull out not only the extension, but
your natural lash as well.
-Do not remove the extensions on your own
-Always brush your lashes in the morning and at night.
Initial: ______________________
As your natural lashes grow and shed during the natural growth cycle, you will
need lash fills. It is important to have 75% of the extensions on your lashes in order
to maintain the desired clean, full consistent look. Recommended fills are every
2 weeks.
Initial: _____________________
The Beauty Bar
www.TheBeautyBar.me
631-765-9600
info@TheBeautyBar.me