Glow and Grace Consent Form

1

Client Details

These details help Glow and Grace keep an accurate treatment record.

Full name

Phone number Email address

Date of birth Emergency contact optional

2

Age and Service

Glow and Grace only provides these services to clients aged 18 and over.

I confirm that I am 18 years of age or older.

Service selected Lash lift Lash tint Lash lift and tint

3

Health Screening

Please answer honestly so your technician can decide whether the service is suitable today.

I understand that I must tell my technician about any condition, allergy, sensitivity, medication, or previous reaction that may affect my treatment.

4

Treatment Acknowledgements

Please read each statement before continuing.

Glow and Grace does not provide patch testing for lash lift or tint services. I understand that allergic reactions, irritation, or sensitivity may still occur, even if I have had similar treatments before without any issue. I understand that lash lift and tint services involve products being used close to my eyes. Possible reactions or outcomes may include redness, swelling, itching, watery eyes, stinging, irritation, allergic reaction, chemical sensitivity, infection, blurry vision, lash dryness, lash breakage, over-processing, uneven results, or poor lift or tint retention. I agree to tell my technician immediately if I feel burning, pain, stinging, or significant discomfort during the service.

Client responsibility

I confirm that the information I have provided is accurate and complete to the best of my knowledge. I understand that results may vary depending on my natural lashes, previous treatments, home products, skin sensitivity, aftercare, and individual response to the treatment. I agree to follow the aftercare instructions provided by Glow and Grace.

Medical advice

Glow and Grace does not provide medical advice. If I experience significant pain, swelling, irritation, vision changes, or symptoms that concern me after my treatment, I should seek medical advice promptly.

5

Privacy and Photos

Your information is collected to assess suitability, keep a treatment record, contact you about your appointment or service history, and manage client safety.

I understand that this may include my contact details, date of birth, health screening answers, treatment notes, signature, and optional photos. Glow and Grace will use this information for business and client-care purposes.

6

Final Consent

The date and time will be captured automatically when this form is submitted.

I have read and understood this form. I have had the opportunity to ask questions before my treatment. I understand the possible risks and outcomes of the selected lash service and consent to Glow and Grace performing the treatment.

Typed full name Technician name

Drawn signature

Lash service consent

Consent recorded