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Consultation Form

Eyelash Extensions

BY SIGNING BELOW, I ACKNOWLEDGE THAT THE NATURE AND PROCESS OF EYELASH EXTENSION PROCEDURE HAS BEEN FULLY EXPLAINED TO ME, I UNDERSTAND THAT THERE ARE USUAL RISK INHERENT IN THE PROCEDURE AND THE POSSIBILITY OF COMPLICATIONS DURING AND AFTER IT’S PERFORMANCE AS LISTED BELOW.


  • THE ADHESIVE CONTAINS FUMES WHICH MAY CAUSE AN ALLERGIC REACTION IN CERTAIN CIRCUMSTANCES. NEVER OPEN YOUR EYES DURING THE APPLICATION AS THE ADHESIVE AND FUMES MAY CAUSE TEMPORARY OR PERMANENT BLINDNESS. TECHNICIANS AT LASH VISION TAKT THE UTMOST CARE AND ARE TRAINED TO THE HIGHEST STANDARDS.
  • YOU MUST WASH YOUR LASHES IN COOL WATER AND PROFESSIONAL CLEANSER WITHIN 20 MINUTES OF YOUR TREATMENT TO MINIMISE REACTION POSSIBILITY.
  • YOU MUST NOT WEAR MAKEUP, RUB YOUR EYES OR PARTICIPATE IN ACTIVITIES SUCH AS SPORT, HOT SHOWER, SAUNA OR SPA WITHIN 24 HOURS AFTER YOUR TREATMENT.
  • THERE ARE SOME PRODUCTS WHICH MAY INFLUENCE THE LONGEVITY / RETENTION OF EYELASH EXTENSIONS: MEDICATION, MAKEUP REMOVERS, STRESS, MASCARA, EYELASH GROWTH CYCLES AND SKIN CARE PRODUCTS.
  • EYELASH EXTENSIONS REQUIRE CLEANSING DAILY WITH PROFESSIONAL PRODUCTS
  • NO OIL BASED PRODUCTS ARE TO BE USED ON EYELASH EXTENSIONS.
  • EYELASHES SHOULD NOT BE PERMED OR TINTED WITHIN 48 HOURS OF EXTENSION REMOVAL AND NEVER WHILST WEARING LASHES
  • REFILLS ARE REQUIRED EVERY 2-3 WEEKS.
  • CORRECT EYELASH CARE IS REQUIRED TO MAINTAIN AND PROTECT LASHES, INCORRECT CLEANSING OR BRUSHING CAN CAUSE DAMAGE.
  • NOT ALL HAIR IS AT THE SAME STAGE AS GROWTH, THEREFORE SOME LASHES WILL SHED BEFORE OTHERS, THIS IS NOT DUE TO IMPROPER APPLICATION. ON AVERAGE YOU WILL LOSE 1-5 EXTENSIONS DAILY.
  • NEVER ATTEMPT TO REMOVE EYELASH EXTENSIONS YOURSELF. LASHES MUST BE REMOVED BY A QUALIFIED TECHNICIAN. IMPROPER CARE CAN CAUSE DAMAGE TO YOUR NATURAL LASHES.
  • THERE IS NO GUARANTEE THAT THE PROCEDURE WILL LAST THE RECOMMENDED TIME. NO REFUND WILL BE ISSUED ON ANY PROCEDURES.

I UNDERSTAND THAT I HAVE THE RIGHT TO A PATCH TEST 24 HOURS PRIOR TO APPLICATION.


IF I WAIVE THE RIGHT TO SUCH A TEST I WILL BE FULLY RESPONSIBLE FOR ANY CONSEQUENCES OF ANY ALLERGY THAT MAY RESULT IN ASSOCIATION WITH THE EYELASH EXTENSION PROCEDURE.


I UNDERSTAND I NEED TO INFORM MY THERAPIST OF ANY MEDICAL CHANGES THAT HAVE OCCURRED PRIOR TO HAVING MY LASHES INFILLED.


I HEREBY ACKNOWLEDGE THAT ALL INFORMATION PROVIDED IS CORRECT AND THAT I AM FULLY AWARE OF ALL THE RISKS OF THE EYELASH EXTENSION APPLICATION PROCEDURE.


I THEREFORE TAKE FULL RESPONSIBILITY FOR ALL POSSIBLE OUTCOMES OF THE PROCEDURE AS LISTED ABOVE.

Due to the 2019-2020 outbreak of the novel Coronavirus (COVID-19), Lash Vision is requires by the governing regulations set out by Victorian State ministers to hold a client details for minimum for 28 days. Lash Vision are also adhering to enhanced sanitation/disinfection procedures in accordance with the Australian Government Department of Health Regulations.


Symptoms of COVID-19 include:
- Fever
- Fatigue
- Dry Cough
- Difficulty Breathing


By digitally signing this form I agree to the following:

  • I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above WITHIN THE LAST 14 DAYS.
  • I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.
  • I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 WITHIN THE PAST 30 DAYS.
  • I affirm that I, as well as all household members, have not traveled outside of the country, or to any city considered to be a "hot spot" for COVID-19 infections WITHIN THE PAST 30 DAYS.
  • I understand that Lash Vision nor their students cannot be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by each client.

Lash Vision is following these enhanced procedures to prevent the spread of COVID-19:
- No Guests to accompany those scheduled for services
- Each client required to sanitise hands upon arrival and before leaving
- Your Technician will thoroughly clean hands and will wear a clean mask for each client
- All product bottles used during treatment will be placed on the trolley for disinfection and disposable items will be used when possible
- Fresh linen and head support covers will be used for each client
- All surfaces including treatment bed, will be wiped thoroughly with hospital grade disinfectant before and after each client according to the manufacturer's directions
- Additional time included between appointments to prevent client contact with each other


By signing below, I agree to each statement above and release Lash Vision from any and all liability for the unintentional exposure or harm due to COVID-19.