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Lash extension consent form

Patch test, adhesive sensitivity and the aftercare rules, on one form the client signs before the first set.

Free, and no account needed to start. Send the link however you normally would: text, email, or a group chat. People fill it in on their phones. Sort the answers, search them, download them as a spreadsheet. 100 replies a month on the free plan.

Or download the printable PDF. Free, no email address, ready to print and pin up.

Already have your own version? Upload it and keep your wording.

The form people fill in, and the list you get back

This is the real form, not a screenshot of one, and it works. Below it is what you see as the answers come in.

Lash extension consent

23 questions · takes about 6 min

Service booked
Patch test result
Have you had lash extensions before?
Do any of these apply to you?

Select all that apply.

I consent to before and after photographs
Client's signature
Sign above with your finger or mouse

By signing here I agree that this signature, and the answers submitted with it, are mine and have the same effect as a signature on paper.

All 23 questions

  1. Client's full name (required)
  2. Date of birth (required)
  3. Phone number (required)
  4. Email address
  5. Date of appointment (required)
  6. Lash technician
  7. Service booked (required)
  8. Date of your patch test (required)
  9. Patch test result (required)
  10. Have you had lash extensions before? (required)
  11. Do any of these apply to you? (required)
  12. Medications and eye drops you use
  13. Allergies and sensitivities
  14. I understand the appointment can take up to two hours with my eyes closed (required)
  15. I understand extensions shed with my own lashes and need infills every two to three weeks (required)
  16. I agree to keep my lashes dry for the first 24 hours and to avoid steam, saunas and sunbeds in that time (required)
  17. I agree to avoid oil-based products, waterproof mascara and lash curlers (required)
  18. I agree not to pull, pick or cut the extensions, and to book a professional removal instead (required)
  19. I understand the risks: irritation, allergic reaction, temporary redness, and damage to natural lashes if aftercare is not followed (required)
  20. I confirm I have disclosed any eye condition, allergy or medication that applies to me (required)
  21. I consent to before and after photographs (required)
  22. Client's signature (required)
  23. Date signed (required)

You can reword any of these, or add your own, after you create it.

An example of what you see when answers come in, with three replies
24 Aug, 08:59Fatoumata Diallo1985-11-06(305) 555-0177f.diallo@example.com2026-08-27KayaRemoval2026-08-25Not yet doneYes, elsewhere — currently wearing themAlopecia or lash lossNoneNone knownYesYesYesYesYesYesYesNo2026-08-24
23 Aug, 15:47Marisol Vega1990-02-28(786) 555-0121m.vega@example.com2026-08-26NiaInfill2026-05-04Existing client, previously testedYes, here beforeDry eye or chronic eye irritationPreservative-free artificial tearsMicropore tape — itchyYesYesYesYesYesYesYesYes, for my record only2026-08-23
22 Aug, 10:14Sianne Beaumont1998-07-13(305) 555-0192s.beaumont@example.com2026-08-25NiaHybrid full set2026-08-23No reactionNo, this is my first setContact lens wearerNoneNone knownYesYesYesYesYesYesYesYes, and they may be used in marketing2026-08-22

Scroll sideways for the rest of the 23 answers, and press any heading to sort by it. In your own form you can search the answers as well, and download them as a spreadsheet at any time.

The patch test and the consent belong on one form

Lash adhesive is cyanoacrylate, and a reaction to it is the single most common insurance claim in this trade. Insurers and training bodies expect a patch test 24 to 48 hours before a first set, and the commonest gap in a studio's records is a patch test that was done and never written down.

Recording the date and the result on the consent itself means one document answers both questions, and the "existing client, previously tested" option keeps the same form usable for infills without pretending a test happened today.

The eye-condition list is the part that changes the answer

Active conjunctivitis, blepharitis, recent eye surgery and daily glaucoma drops are the screening answers that mean postponing or referring rather than proceeding. Dry eye and contact lens wear change the plan rather than stopping it.

Trichotillomania and alopecia are on the list because extensions applied to lashes that are already being lost make the loss look like the technician's fault, and the conversation is far easier before the set than after it.

Aftercare is three promises, not one paragraph

Water in the first 24 hours, oil-based products, and picking are the three things that ruin a set, and they fail in different ways. A single "I have read the aftercare" tick box does not register with somebody skim-reading on a phone; three specific lines do.

Not picking is worth its own line for the same reason it is on a chemical peel form: almost every damaged natural lash line is a picked one, and the client who picks is the client who did not read the leaflet.

Set the two expectations that generate refund requests

That the appointment takes up to two hours with the eyes closed, which surprises first-timers and matters to anyone claustrophobic. And that extensions shed with the natural lash cycle and need infilling every two to three weeks, which clients frequently hear as "they fell out early".

Sent with the booking, the patch test happens on time

The practical problem with patch testing is not the test, it is the 48 hours. A link sent when the appointment is booked carries the reminder and collects the record, and comes back timestamped rather than pencilled into a diary.

If your insurer requires its own wording, upload that PDF instead — the questions are read off the document and the policy language stays exactly as written.

Check your insurer and your state board

Patch-test intervals, record retention and what a licensed technician may perform vary by insurer and by state. This is a starting point, not a compliance document.

Questions people ask

What should a lash extension consent form include?

Client details and appointment date, the service booked, the patch test date and result, whether they have had extensions before, screening for cyanoacrylate allergy, eye infections, blepharitis, dry eye, recent eye surgery, glaucoma drops, lash pulling and alopecia, medications and eye drops, allergies including tape and adhesives, acknowledgement of the appointment length and the natural shed cycle, three specific aftercare agreements, the risks, photography consent and a dated signature.

How long before lash extensions should a patch test be done?

Most insurers and training bodies require 24 to 48 hours before a first set. The commonest record-keeping failure is a test that was done and never written down, which is why this template records the date and result on the consent itself.

Who should not have lash extensions?

A known allergy to cyanoacrylate or acrylic adhesives, an active eye infection, blepharitis and recent eye surgery are the standard reasons to refuse or postpone. Dry eye, contact lenses and daily glaucoma drops usually change the plan rather than preventing the treatment, and belong on the form so the technician knows before the client is lying down.

Why does the form ask about lash pulling and alopecia?

Because extensions applied to a lash line that is already thinning make the loss look like the technician caused it. Having it disclosed and recorded before the set turns a dispute into a conversation that already happened.

Is this lash extension consent form free?

Yes. Download the printable PDF with no account and no email address, or send the online version when the appointment is booked so the patch test happens in time.

Ready to send it out?

Every question above is already written. Make it a form, get your link, and send it. Reword anything first if your group asks it differently.

Free, no account needed to start, and the printable PDF stays one click away.

Already have your own version of this form?

You build nothing. Drop the PDF here, or photograph the printed copy, and the questions are read off it: no canvas, no dragging a box onto each field, no mapping step. The wording your organisation already approved stays exactly as it is, and you get a link that collects the answers back as a spreadsheet — and as the original document, filled in.

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