Name *

First Name

Last Name

Phone

(###)

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Date

Your appointment date. If unknown, please put today's date.

MM

DD

YYYY

Please agree to each statement after reading: *

I understand that lash, brow, and related esthetic procedures involve certain risks, including—but not limited to—eye irritation, discomfort, itching, pain, or in rare cases eye infection. I acknowledge these risks and accept them.

*

I understand that advanced solutions and conditioning products will be applied to my lashes and/or brows. I consent to their use and understand their purpose in supporting the treatment.

*

I understand and agree to follow the aftercare instructions provided by my technician and that failing to adhere to aftercare guidance may lead to suboptimal or undesirable results.

*

I understand that certain treatments, such as lash lifts, may require me to remain reclined with my eyes closed for up to 60 minutes. I acknowledge that certain medical conditions or discomforts may deem me unsuitable for the procedure.

*

I agree not to open my eyes at any point during the procedure unless instructed by the technician, to minimize risk and help ensure a successful result.

*

I understand that staying relaxed and quiet during the procedure helps ensure the best possible results for my service.

*

I confirm that I am not currently pregnant or breastfeeding. (If applicable, please note: pregnancy or nursing may limit suitable treatment options; please consult your technician if unsure).

*

This agreement applies to both this specific treatment and any future procedures performed by any Dime Salon Inc. technician. I confirm I am at least 18 years old, or that I have obtained consent from a parent or legal guardian.

*

I release Dime Salon Inc., its technicians, and its staff from liability related to this procedure. I understand that treatment effects vary, typically lasting 6–8 weeks, and that Dime Salon Inc. cannot guarantee results. I also acknowledge that technician errors are beyond their liability. I am aware that to reduce the risk of adverse outcomes, following aftercare guidance is strongly advised.