Intake and Consent Form – Knoxville

I have agreed to have services performed by Wisp Lashes. Before my qualified professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.

For valuable consideration, in order to have my Wisp Lash es eyelash extensions applied and/or removed from my eyelashes:

1. Waiver of Liability. I UNDERSTAND THERE ARE RISKS ASSOCIATED WITH HAVING ARTIFICIAL EYELASHES APPLIED TO AND/OR REMOVED FROM MY EXISTING EYELASHES, AND THAT NOTWITHSTANDING THE UTMOST OF CARE IN THE APPLICATION OR REMOVAL OF THESE PRODUCTS, THERE STILL EXIST RISKS ASSOCIATED WITH THE PROCEDURE AND PRODUCT ITSELF, WHICH INCLUDE, WITHOUT LIMITATION, EYE IRRITATION, EYE PAIN, DISCOMFORT, AND, IN RARE CASES, BLINDNESS WHEN IMPROPERLY HANDLED. AS ART OF THIS PROCEDURE, I UNDERSTAND THAT A CERTAIN AMOUNT OF EYELASH ADHESIVE MATERIAL WILL BE USED TO ATTACH THE ARTIFICIAL WISP LASHES TO MY EXISTING EYELASHES. EVEN THOUGH THE PROFESSIONAL MAY APPLY OR REMOVE MY WISP LASHES PROPERLY, I UNDERSTAND ADHESIVE MATERIAL MAY BECOME DISLODGED DURING OR AFTER THE PROCEDURE, WHICH MAY IRRITATE MY EYES OR REQUIRE FURTHER FOLLOW-UP CARE, AT MY OWN EXPENSE TO PREVENT DAMAGE TO MY EYES. I ALSO UNDERSTAND THERE IS MORE THAN ONE TECHNIQUE FOR APPLYING WISP LASHES TO MY EYELASHES, AND I WILL NOT ATTRIBUTE ANY LIABILITY TO PROFESSIONAL OR LONG LASH, LLC AS A RESULT OF THIS PROCEDURE OR THE USE AND CARE OF THESE LASHES. I ALSO AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS PROFESSIONAL AND LONG LASH, LLC FROM ANY AND ALL CLAIMS, ACTIONS, EXPENSES, DAMAGES AND LIABILITIES, INCLUDING REASONABLE ATTORNEYS’ FEES WHICH MIGHT BE ASSERTED AGAINST THEM AS A RESULT OF MY HAVING THIS PROCEDURE PERFORMED, OR MY PURCHASE OF THESE LONG LASH, LLC. PRODUCTS. AS USED IN THIS AGREEMENT, THE TERMS “PROFESSIONAL” AND “LONG LASH, LLC” INCLUDE ALL OF THEIR RESPECTIVE OFFICERS, DIRECTORS, AGENTS, EMPLOYEES, SUCCESSORS AND ASSIGNS.

PLEASE CHECK HERE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE WAIVER OF LIABILITY

2. Permission to Use Pictures. I hereby grant to Professional and LONG LASH, LLC the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after this procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary by Professional or LONG LASH, LLC. I further expressly assign any copyright in these photographs to LONG LASH, LLC. I also grant my consent for Professional and LONG LASH, LLC to use my image and likeness as contained in these photographs for any advertising or other purposes, along with any comments I may provide. Please use these images with the following:

my own nameno name to be useda fictitious name:

3. Care and Maintenance. I agree to follow the care and maintenance instructions provided by Long Lash, LLC and/or Professional for the use and care of my Wisp Lashes, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my Wisp Lashes or may cause my lashes to fall off prematurely. Knowing this I agree to follow these tips and any other my Lash Professional suggests for best results: I will avoid oil based eye products as these will loosen the bond of my Wisp Lashes. I will avoid getting my lashes wet within the first 24 hours after my application. For the first two days after application I understand it is best to avoid swimming, saunas or steam rooms. If I experience any itching or irritation, I agree to contact my Wisp Lashes Professional immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint my Wisp Lashes. I agree to not pick, pull or rub my Wisp Lashes. I understand that I should not attempt to remove my lash extensions on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.

4. No Known Medical Conditions / Informed Consent. I have read and completed the Wisp Lashes Client Intake Form in its entirety and in truth. I acknowledge that I have been advised of the potential harmful or negative side effects (such as the premature shedding of my eyelash) that the lash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrolate or formaldehyde which in small amount may be present in the adhesive. I understand that the procedure requires that I lay still for up to 2 hours or longer with my eyes shut, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to the professional’s or Wisp Lashes instructions or these warnings.

If any action is brought to enforce the terms of this Agreement, the prevailing party shall be entitled to its costs and reasonable attorneys’ fees. Any claims arising out of this agreement will be resolved through binding arbitration using the rules of the American Arbitration Association.

This agreement will remain in effect for this procedure, and all future procedures conducted by Professional or any other professional conducting business at the salon/spa establishment listed above.

I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am over 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have had my parent or legal guardian consent to this agreement, and his or her relationship to me is as follows:

By his or her signature below, he or she ratifies and consents to this procedure under these terms.

By Signing below, you agree to the following statements:

• I understand that eyelash extensions are not permanent and will shed along with my natural lashes on average of 5-7 lashes per day

• I understand that a “fill” will only be performed if I have retained at least 50% of my extensions previously applied and the appointment is for no more than 21 days after my last fill or full set. Otherwise, my appointment will be considered a “full set”

• I understand there are risks associated with services rendered at Wisp Lashes. These may include but are not limited to: irritation, discomfort, and in rare cases allergies or infections may occur.

• I understand that if I experience any of the above issues, I must immediately inform my lash artist who may choose to cease treatment and remove the eyelash extensions.

• Should irritation, discomfort, or infection occur, I will immediately seek medical assistance and understand that I am financially responsible for such treatment.

• I understand and agree to follow the aftercare instructions provided and available at www.wisplashes.com and understand that failure to do so may cause the extensions to fall out prematurely, or cause irritation. This include the use of mascara and/or eye liner.

• I understand these treatments are completely voluntary, and I freely consent to having them done.

• I have been given the opportunity to ask any questions I may have had, and the treatments I will be receiving have been explained to me.

• I understand and consent to have my eyes closed and covered for the duration of my service to prevent any issues from adhesive fumes or irritations.

• I understand that while eyelash extensions are being applied, I need to remain still and not talk or move my hands and body.

• I understand that while my eyes are padded, taped, and closed for services, I cannot use my cell phone.

• I understand that if I fall asleep during my service, I may startle, jump, or twitch. This could cause the last artist to poke or stab me with tweezers or other implements used during the procedure. I absolve Wisp Lashes and their employees from any resulting injuries or damages.

• I understand that the use of caffeine and/or other stimulants may cause fluttering of my eyelids and/or result in difficulty keeping my eyes closed which can lead to redness and irritation of the eye from exposure to adhesive fumes.

• I understand that if I experience any burning or discomfort during my session, I am to tell my stylist immediately.

Deposit, Cancellation, and No Statements:

• I understand that a deposit is required to hold all appointments.

• I understand that if I cancel an appointment without a 24-hour or more notice from the time of the appointment, Wisp Lashes has the right to run the card on file for the full balance of the appointment and require a cancellation fee to be collected before honoring or booking subsequent apointments.

• I understand that if I no-show a scheduled appointment, Wisp Lashes has the right to run the card on file for the full balance of the appointment and require a cancellation fee be collected before honoring or booking subsequent appointments.