I have agreed to have Blvd spa to perform eyelash perming and/or eyebrow henna. 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 Blvd spa perform eyelash perming and/or eyebrow henna. If you checked off or answered yes to any of the questions above, Blvd Spa advises you to see your doctor regarding the risks or hazards of the proposed treatment before signing this consent form. If you choose not to see your doctor, you must acknowledge by signing below that Blvd Spa has asked you to visit your physician to obtain medical clearance before beginning treatments. You have elected not to do so and assume all risks for any injures arising from undertaking any treatments due to a known medical condition. Blvd spa still reserves the right to not begin any treatment under these conditions.
Waiver of Liability: Although every precaution will be made to ensure your safety and well-being before, during and after your procedure please be aware that your procedure is safe and there is no recovery time for most people. I understand there are risks associated with having eyelash perming and/or eyebrow henna applied to and/or removed from my existing eyelashes and/or eyebrows, 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, stinging or burning, blurry vision and, in rare cases, blindness when improperly handled. I understand that if the perming/henna agents, products come into contact with my eyes, my eyes will be flushed with water and saline solution and medical attention is required. As part of this procedure, I understand that a certain amount of eyelash/eyebrow produc material will be used to apply the product to my existing eyelashes/eyebrows. Even though the Professional may apply or remove the producta properly, I understand product/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 product to my eyelashes/eyebrows, and I will not attribute any liability to Professional or Blvd spa as a result of this procedure or the use and care of my eyelashes/eyebrows. I understand that while every attempt to be made to provide you with a procedure that is exactly as you requested but every person reacts to products differently and you final results might differ from what you initially requested. I also agree to defend, indemnify and hold harmless Professional and Blvd spa 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 Blvd spa products. As used in this agreement, the terms “Professional” and “Blvd spa” include all of their respective officers, directors, agents, employees, successors and assigns.
Care and Maintenance: I agree to follow the care and maintenance instructions provided by Blvd spa and/or Professional for the use and care of eyebrows/eyelashes, 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 eyelashes/eyebrows or may cause my eyelashes/eyebrows to fall off prematurely. Knowing this I agree to follow these tips for best results: I will avoid oil based eye products as these will loosen the bond of the product. I will avoid getting my eyelashes/eyebrows 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 Blvd spa 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 eyebrows/eyelashes I agree to not pick, pull or rub my eyebrows/eyelashes. I understand that I should not attempt to remove product on my own or with any product, but that the procedure requires that my lash extensions be professionally removed.
No Known Medical Conditions / Informed Consent: I have read and completed the Blvd spa Consent 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/eyebrows) that the procedure or removal may cause to those who have specific medical or skin conditions. I understand that the products/materials are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate 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 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 Blvd spa instructions or these warnings.
Disclaimer: I agree that I will not hold blvd spa and its employees liable for any injury or condition that arises from application of service despite completion of this form. This form is intended as an assessment tool only and serves as a guide for the application of service not for medical treatment or medical assessment. If I experience pain or discomfort during the session, I will immediately inform the professional so that the pressure may be adjusted. I understand that Professionals are not qualified to perform spinal or skeletal adjustments, diagnosis, prescribe or treat any physical illness, and that nothing in the course of the session given should be construed as such. Draping will be used during this session. No guarantee has been given by anyone as to the results that may be obtained by this treatment. The clients and all persons on the premises by invitation of the clients hereby hold blvd spa, its employees, independent contractors, the LLC or any individual connected in any way to blvd spa, Only the body area being worked on will be uncovered. Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorization for the session.
I have stated all conditions that I am aware of and this information I provided is true and accurate to the best of my knowledge. I agree to inform my professional immediately of any change in the conditions stated above on every visit moving forward. This consent form will stay on file and be used for this service and all future sessions. I acknowledge that this information is confidential and intended for review by blvd spa; that a medical referral may be requested of me; and that blvd spa is not liable for the management of any condition.
