About this template
This Eyelash Extension Consent Google Form template is designed for lash technicians and salon owners to collect vital health information and legal waivers before performing services. It covers essential pre-procedure screening, including eye health history, medication usage, and potential contraindications like recent surgeries or allergies. By gathering this data upfront, you ensure your clients are suitable candidates for extensions while protecting your business with clear liability language.
Using Doc2Form to deploy this template allows you to digitize your intake process, eliminating paper clutter and ensuring you have a timestamped record of every client's consent. The form is structured to guide the client through necessary safety disclosures, maintenance expectations, and policy acknowledgments, creating a professional and transparent experience from the moment they book their appointment.
Key features
- Comprehensive health and eye-history screening
- Clear liability and no-refund policy acknowledgments
- Pre-procedure care and maintenance instructions
- Mobile-friendly design for easy client completion
- Automated timestamping for all signed agreements
Use cases
- New client intake for lash extension appointments
- Annual health history updates for returning customers
- Liability documentation for salon insurance compliance
- Pre-service education on aftercare and maintenance
What this form collects
- Full Name (Short answer)Please enter your legal first and last name.
- Date of Birth (Date)Required for age verification.
- Do you have any known allergies to adhesives or latex? (Multiple choice)Please be specific if you have had reactions to eyelash glue in the past.
- Have you had any eye surgery in the last 6 months? (Multiple choice)Includes LASIK, blepharoplasty, or other corrective eye procedures.
- Are you currently pregnant? (Multiple choice)Some clients may experience sensitivity due to hormonal changes.
- Liability Release (Checkboxes)I understand the risks involved and release the technician from liability regarding potential allergic reactions or irritation.
- No-Refund Policy (Checkboxes)I acknowledge that all services are non-refundable once performed.
- Client Signature (Short answer)Please type your full name as a digital signature.
FAQ
Why do I need a consent form for eyelash extensions?
Consent forms are essential for identifying potential allergies, eye conditions, or medical contraindications that could make the procedure unsafe for the client, while also documenting the client's agreement to your salon's policies.
Can I customize the questions in this template?
Yes. Once you convert this template to a Google Form, you have full control to add specific salon policies, update your address, or include additional health questions relevant to your specific techniques.
How do I ensure the client has read the liability section?
We recommend using mandatory checkbox questions for all critical policy acknowledgments, such as the no-refund policy and liability release, to ensure the client must interact with each point before submitting.
Is this form compliant with privacy regulations?
Google Forms provides a secure way to collect data. Ensure you have a clear privacy policy linked in the form description to inform clients how their sensitive health information is stored and protected.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.