Lash Extension Consent Form
Consent form for eyelash extension services including allergy disclosures, adhesive sensitivity warnings, and aftercare acknowledgment.
Last updated: April 2026
Researched by the CheckinPulse Research Team
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This is what your clients will fill out. 13 fields, mobile-friendly.
Lash Extension Consent Form
All fields marked with * are required
Consent / Waiver Language
This waiver text is included at the bottom of the form, above the signature field.
I understand that eyelash extension application involves bonding synthetic fibers to my natural lashes using adhesive containing cyanoacrylate. I acknowledge the risks including but not limited to: allergic reaction, eye irritation, redness, swelling, natural lash damage, and sensitivity to fumes. I have disclosed all known allergies, eye conditions, and medications. I understand that a patch test is recommended for first-time clients. I agree to follow all aftercare instructions and understand that failure to do so may result in premature lash loss or irritation. I release the service provider from liability for reactions resulting from undisclosed conditions.
Frequently Asked Questions
Lash adhesive contains cyanoacrylate, which causes allergic reactions in about 3-5% of clients. Without a signed consent form, you're exposed to liability if someone has a reaction. It also documents that you asked about eye conditions and medications that could cause problems.
A patch test is recommended for first-time clients — apply a small amount of adhesive behind the ear or on the inner wrist 24-48 hours before the appointment. Repeat clients who've had no issues typically don't need one every visit, but note it on their form if they decline.
Focus on cyanoacrylate sensitivity (the main adhesive ingredient), latex allergies (if you use latex tools), and formaldehyde sensitivity. Also ask about general eye conditions like blepharitis or chronic dry eye, which can worsen with extensions.
They can file a claim, but a signed consent form is your best defense. It proves they were informed about cyanoacrylate risks and disclosed their medical history. Courts generally side with the provider when proper informed consent was obtained and documented.
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