Eye Lash Extension Consent Form
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  • Consent for Application Of Extensions 

    I agree to have eyelash extensions applied/retouched/removed to/from my natural lashes by Lacasamely. 

    I understand there are risks associated with having artificial eyelashes applied to or removed from my natural eyelashes. 

    I further understand that as part of the procedure the following conditions can occur: allergy to adhesive, swelling of the lid(s), eye irritation, eye pain, eyelid itching, discomfort, and in very rare occasion, eye infections or blindness. 

    I agree that if I experience any of the above conditions I will notify my service provider IMMEDIATELY. I further understand that the eyelash extensions will be removed to prevent further irritation and inflammation. Should I experience any change in vision I will contact my Ophthalmologist or Optometrist immediately. 

    I understand the services may take over 2-3hours  I consent to having my eyes closed and will lay as still as possible without chewing on gum and keep talking to a minimum to prevent the movement of my eyelids.

    I also understand that eyelash fills/fix/touch up appointments are needed to maintain lash extensions due to the natural shedding process of eyelashes. We recommend a 2 week follow up after you inital visit. At that time we will asses if to keep you at 2 weeks or extend your fill visits.

    I understand that my lash stylist will use proper application, but lash extension applications can, in some cases, cause a temporary decrease in the fullness and/or length of my natural lashes. 

    I also understand that if thinning is noted by my lash stylist she may recommend that the lash extensions be shorter, or less full, or even temporarily removed. 

    I am aware that if I should decide to discontinue lash extension fill touch up appointments or have my extensions removed that my eyelashes may appear shorter for up to 12 weeks, the length of a normal eyelash growth cycle. 

    I give LA CASA MELY and service providers permission to take photos of my face, lashes and/or brows without monetary compensation and without name recognition for advertising, reference or training purposes.

    I understand that there are many variables including my eyelash growth cycle, sensitivity to adhesive, my lifestyle and use of cosmetics that determine how long my lash extensions will last. 

    I realize that the adhesive being used for my extensions is not regulated by the FDA, therefore it is not an FDA approved product. 

    Finally, I understand that not all risks and/or hazards of the procedure are reviewed in this document nor could they be. I understand safety precautions will be taken during this procedure but safety cannot be guaranteed. 

    I release LA CASA MELY and service providers from all liability associated with this procedure and I will do my part to maintain the health of my eyes and eyelash extensions by following all aftercare instructions.

    I will contact my lash stylist should I have any questions or concerns.

  • AfterCare Instructions

    Your lash extensions are attached to your own individual lashes and will shed as your natural eyelashes shed. Maintaining your lash extensions will require regular visits to attach new extensions to your new eyelashes as they regenerate.

    With a few simple care instructions you will be on your way to enjoying your luscious long lashes.

    To increase the longevity for your lash extensions, it is advised to avoid touching them unnecessarily. The less you do to your lash extensions the longer they will last.

    Immediately following your lash extension procedure:
    You may notice a red appearance to the whites of your eyes. This is due to the fumes of the adhesive and will usually diminish within 30-120 minutes, but it may take 24 hours. Using moisturizing eye drops may help alleviate the redness. Eyelash adhesives take upto 24 hours to cure/dry completely.

    During the initial 24 hours:
    Do not get your lash extensions wet this includes crying, tearing, and sweating. Avoid any eye makeup, steam from facials, saunas, and hot yoga and sweating from the gym, tanning beds, chemical peels, waxing around the eye area and laser treatments of any kind. 

    After your 24 hour mark - Wash your eyelids with lash artist approved lash wash, allow your extensions to dry before brushing with lash wand.

    Following these instructions will increase the life of your lashes, thus decreasing the cost and time required for maintenance.

    General guidelines to extend the life of your lash extensions:
    Avoid oil-based products on or around your eyes as oil will break down the lash adhesive. This includes eye makeup removers, eye creams, eyeliners, mascara, but not limited to oils in shampoos and conditioners, hair products and sprays.
    If you feel like you need to use mascara, talk to your lash stylist to see about increasing the length and thickness of your lash extensions. If you still feel mascara is needed, use a lash extension-friendly mascara recommended to you by your lash stylist.

    DO NOT:
    Attempt to remove eyelash extensions youself. We offer free removals. Do not use any mascara, lash strips or eyelash curlers; sleep on your face; rub, pick, or pull your lash extensions or eyelashes. Avoid being close to hot ovens, grills, or even cigarettes can cause lashes to melt at the tips or striaghten out.

    DO:
    Wash your lashes with lash artist approved lash wash. Accepted alternative is Original antibacterial Foam Dial Soap. The use of Lash Wash on the lids is to remove any naturally occurring oils produced by the eyelids.

    If you experience any pain, swelling, irritation or significant itching please call or text us at (951)449-3570

  • Before, During & Right After Your Appointment:


    you have 24 to 48 hours or let me know to reschedule a deposit of $20 towards your service is required for your appointment. If anything changes you need to let me know please read the highlights and policies in my Instagram before booking

    If you are experiencing any irritation, burning, itching, swelling, or sensitivity on the day of your appointment, you must let me know before leaving your house and before we begin the service.

    Once the service is finished, you will be asked if everything feels okay or if you like how it looks. If you feel any discomfort, don’t like the look, or have concerns, you must speak up before leaving my house.

    If you leave my house without saying anything, that means you’re happy with the service and La Casa Mely is no longer responsible for any discomfort, reactions, or dissatisfaction that may show up later.

     

    48-Hour Feedback Policy:

    If something comes up after your appointment — like irritation, discomfort, allergic reaction, or poor lash retention — you have 48 hours to contact me.

    This 48-hour window includes:

    • The day of your appointment

    • The following day

    If you don’t contact me within 48 hours, I am not responsible for any issues, and no corrections, touch-ups, or refunds will be offered.

  • Referral Program:

    Refer a family, friend, or stranger and receive 25% off a fill (must have 50% retention)

    If you are being referred through this program you can provide the name of the person who referred you at the end so they can receive their referral discount

    Ghislaine Clients Only Referral Program:

    Refer 3 get one Free 

    If you are being referred through this program you can provide the name of the person who referred you at the end so they can receive their referral discount

    3 day guarantee for defective adhesive

    If you experience 50% of lash fall out within the first 3 days and you have followed the take home instructions and did not tear during lash session text/call us (951)449-3570 You must be seen within  those 3 days of your initial set appointment in order to receive a free 1 hour fill.

    If your not seen within those 3 days of initial appointment you are responsible for booking your fill appointment and paying according to lash retention.

    Disclaimer - Tearing during lash application is not included in 3 day guarantee policy.

    If the glue is truly defective everyone done the day you are done will have the same results.

     

     

  • What your follow up visits should look like

    New clients are recommended to book a 2 week follow up appointment in which we expect your retention to be 50% or better (doesnt look like you need a fill).

    If retention is 30% (noticably gappy) book extra time with your lash artist. Additional charges will apply.

    (Ghislaine has additional time built in to fill slots and discounts for good retention services)

    If under 30% retention cancel your fill appointment at least 4 days on advance and rebook for a full set appointment at the earliest convenience

    Your lash artist will decide at that time of your follow up appointment if you need to continue to be followed up at 2 weeks, or push you out to 3 weeks or 4 weeks.

     

     

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    How to correctly wash lashes today and as long as you have extensions:
    Wet Lashes with water

    Squeeze foam lid cleanser to index fingers, and gently place your finger tips with foam soap on eyelids (you should feel half of your index fingers on your lid and half of your finger on your lashes/extensions) You want to gently go back and forth at least 3 times towards your nose and out towards your temples then rinse.

    If you have oily skin you will want to repeat this 2x a day

    If you have a brush to wash place foam on brush, start on edge of eyelid and brush down on the extensions from your temple to your nose and do the same to the other eyelid. Repeat if wearing eye makeup.

     

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