Semi Permanent Eyelash Extensions Disclaimer Full Name: _____________________________________________________________________________ Do you suffer from any of the following?

· Skin disease or disorder · Enema, dermatitis, psoriasis · Inflammation or swelling around the eye · Lack of skin sensation in or around the yes · Eye problems · Eye sensitivity · Recent cosmetic, laser or any other type of eye surgery · Sensitive eyes · Conjunctivitis · Stys · Horeola · Watery eyes · Cysts in eye area · Cataract · Dry eyes · Glaucoma · Eyelid surgery · Hay fever · Dust allergies · Sinus problems · Epilepsy · Diabetes · Keloid scarring · Herticartia Are you doing/taking any of the following: · Herbal remedies · Dieting · Pregnant · Trying to be pregnant · Think you may be pregnant · Had alopecia in the past · Alopecia in the family Are you allergic to any of the following? · Plasters · Rubber · Adhesive tape · Certain product ingredients · Latex If ʻyesʼ to any of the above please give full details: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ The above condition can cause allergy, but other eye and skin and medical conditions may also cause allergy, if you have any illness, allergies of any type please inform your technician each time.

Does your lifestyle involve: · Using sunbeds · Training at the Gym · Sauna and / or steam room use · Swimming and / or Jacuzziʼs · UV exposure If the answer is ʻyesʼ to any of the above, please be informed you are requested to avoid any of these for the next 48 hours after your treatment or treatment top up · What eye cleanser do you use? ______________________________________________________________________ · What facial cleanser do you use? ______________________________________________________________________ · What make up including mascara do you use? _______________________________________________________________________ Office use · Test patch Details _______________________________________________________________________ _______________________________________________________________________ · Test patch date _________________________________________________________ · Test patch time _________________________________________________________ · Area ______________________________________________________________________ · Date checked __________________________________________________________ · Result after test patch __________________________________________________ Treatment details · Lash lengths used _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ · Look client requires _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ · Advice given · Did client take after care form _____________________________________________ · Did client received after care advice _______________________________________

Signature of any witness present during the procedure (if any) _____________________________________________________________________________ Therapist Signature _____________________________________________________________________________

- PLEASE READ CAREFULLY - · Eyelash extensions vary in life span due to the stage of growth the natural eyelash is in, therefore only an approximate life span for each personʼs eyelash extensions can be ascertained. · Lashes will need maintenance treatments every 2-3 weeks · No water must be on the eyelashes for 24 hours · No heat treatments are to be one the eyelashes for 3 days. This includes, sun, saunaʼs, steam room. Jacuzziʼs, sunbeds, eye treatments and spray tan applications. · No eye make up must be applied to the eye lashes for three days · Under no circumstances can the extended lash be curled manually or mechanically. · Eyelash extensions are guaranteed for strictly for one week with the use of a 100% water-based Make up Remover and Cleanser. · If any eyelash extensions are lost within one week Luxx Lashes will replace them free of charge only if the correct eye make up remover / cleanser is used. · If the correct cleanser and make up remover is not used then Luxx Lashes cannot guarantee the lashes at all and this is at the customerʼs own risk. · Strictly no water proof mascara can be used on the extensions and only the advised mascara can be applied half way down the extension (from middle to other tip of lash) · Lashes can only be guaranteed if you use the correct lash cleanser and mascara and is used (request your therapist advise as to the correct products if unclear) · Luxx Lashes do not give refunds. Any lashes that come off must be reported and shown to the therapist within three days or no action can be undertaken to rectify any problems. · Eyelash extensions must be removed professionally and under no circumstances can they be removed with home applications. · The length of lashes used is determined by the length of the natural lash. If the extension required is too long it may cause the natural lash to fall out or the extension to twist downwards or not look natural. · It is advisable to have a small glue test patch prior to the treatment, by signing this disclaimer it is admitted that your test patch was satisfactory. By signing this disclaimer if you have not had a test patch you are taking responsibility if you have a reaction to this treatment. By signing this disclaimer you are acknowledging youhave been offered a test patch and understand all the stated details above and will adhered to them. I have received a full consultation, I understand semi-permanent lashes require ongoing maintenance treatments in order to remain effective, have received an aftercare for and will use the advised aftercare products to cleanse and care for my lashes. I agree to a test patch and photograph of my treatment before and after my treatments, and understand that if I chose not to take a patch test for whatever reason, Luxx Lashes cannot be held liable for any reactions to products or other incidents that may occur. Signed Print Name

_____________________________________________________________________________ Date _____________________________________________________________________________ Address: _____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Contact Tel: _____________________________________________________________________________ Email: ________________________________________________________________________ (TEAR OFF)

Luxx Lashes Eyelash Extensions Customer Home Care Disclaimer for customers

· No Water, make up and eye care of any type can be used on the extensions for 48 hours · A 100% water-based eye cleanser / make up remover must be used Please do not use other brands of eye cleanser / make up remover as these can harm, damage, weaken and remove the extensions · Luxx Lashes advises only a specified semi-permanent lashes mascara to be used · Lasting effects of the lashes can not be determined before the natural growth cycle of the lash is known, however, rebalances or ʻtop-upsʼ are recommended approximately every 2 – 4 weeks, depending on the growth stage of the natural lash · Do not pull eyelash extensions out or rub eyes vigorously, as this will result in loss of the natural eyelash and possible infection · Eyelash extensions MUST be removed professionally only · Luxx Lashes cannot take responsibility for loss of eyelash extensions if any of the above terms are not adhered to. CANCELLATIONS · There will be a 50% cancellation fee if clients cancel less than 48hrs before appointments. Cancellations of more than 48hrs will not incur a cancellation fee.