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Client Consent Form

Client Consent Formladycode2020-04-22T21:50:22+00:00
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  • CONSENT FOR EYELASH PROCEDURE
  • I have agreed to have eyelash extensions applied to and/or removed from my natural eyelashes. Before my licensed eyelash professional can perform this procedure, I understand I must complete this agreement and provide my informed consent by signing and dating where indicated below.
  • 1. Waiver of Liability. I understand there are risks associated with having artificial eyelash extensions applied to and/or removed from my natural eyelashes, and that notwithstanding the utmost of care in the application or removal of these products, there still exists risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and, in rare cases blindness when improperly handled. As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach artificial eyelashes to my natural eyelashes. Even though the eyelash extension professional may apply or remove the artificial eyelashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require follow-up care, at my own expense to prevent damage to my eyes. I also agree to defend, indemnify and hold harmless my service provider from any and all claims, actions, expenses, damages and liabilities, including reasonable attorneys’ fees which might be asserted against them as a result of my having this procedure performed.
  • 2. Permission to Use Pictures. I hereby grant my service provider the full right to take, publish and reproduce photographs of me, my face, my eyes and/or eyelashes, both before and after the procedure, for any advertising, education, or other purposes whatsoever, including the right to retouch these photographs as deemed necessary. I further expressly assign any copyright in these photographs. I also grant consent to use my images and likeness as contained in these photographs, along with any comments I may provide.
  • 3. Care and Maintenance. I agree to follow the care and maintenance instructions provided to me for the use and care of my eyelash extensions, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that if I do any of the following, it may result in damage to my eyelash extensions or my cause my lashes to fall o" prematurely. Knowing this I agree to follow these instructions for best results: I will avoid oil based eye products as these will loosen the bond of my eyelash extensions. I will avoid getting my lashes wet within 24 hours after application. For the first two days after application, I understand it is best to avoid swimming, saunas or steam rooms. If I experience any itching or irritation, I agree to contact my service provider immediately to have the lash extensions removed. I agree to avoid using waterproof mascara and to not use an eyelash curler, perm, or tint on my eyelash extensions. I agree not to pick, pull or rub my eyelash extensions. I understand that I should not attempt to remove my eyelash extensions on my own or with any product, but that the procedure requires that my eyelash extensions be professionally removed.
  • 4. No Know Medical Conditions / Informed Consent. I have read and completed the Client Intake Form in its entirety and in truth. I acknowledge that I have been advised of the potentially harmful or negative side effects that the eyelash extension procedure or removal may cause to those who have specific medical or skin conditions. I understand that the adhesives and adhesive remover are a skin, eye and mucus membrane irritant and that in rare cases persons may be allergic or have hypersensitivity to synthetics, cyanoacrylate or formaldehyde which in small amounts may be present in the adhesive. I understand that the procedure requires that I lay still for up to 3 hours or longer with my eyes closed, and that if I wear contacts, I must remove my contact lenses for the duration of the lash extension application or removal. I further state that I have no known medical condition that might be aggravated by the procedure or any medical condition that would prevent me from complying with or heeding to instructions or these warnings.
  • If any action is brought to enforce the terms of this Agreement, the prevailing party shall be entitled to its costs and reasonable attorneys’ fees. Any claims arising out of this agreement will be resolved through the binding arbitration using the rules of the American Arbitration Association.
  • This Agreement will remain in effect for this procedure, and all future procedures.
  • I agree that this Agreement is binding upon me, and my heirs, legal representatives and assigns. I represent that I am at least 18 years of age and that I have the right to enter this agreement, or if I am under 18 years of age, I have my parent or legal guardians consent to this agreement and his or her relationship to me is as follows: ___________________________. By his or her signature below, he or she ratifies and consents to this procedure under these terms.
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Tuesday 10am-6:30pm
Wednesday 10am-6:30pm
Thursday 10am-6:30pm
Friday 10am-6:30pm
Saturday 10am-6:30pm
Sunday CLOSED

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San Jose, CA 95118

(408) 816-8809

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The Lady Code Policy

When it is time for your lash extension appointment:

  • Please arrive 5 minutes prior to your scheduled appointment. We operate a strict appointment schedule. If you arrive late, you may not have as much time as you had originally scheduled.
  • Please ensure that you arrive with clean face and mascara/eyeliner free lashes to your appointment.
  • If you wear contact lenses, you will need to remove them at the time of your appointment. Be sure to bring your eyeglasses if needed, for after your application.
  • Remember, you should avoid getting your new set of lash extensions wet for 24 hours.
  • Skin allergies and sensitivities are rare but if you may have a concern, we recommend you come in a week before your appointment and do a patch test. The Lady Code uses the highest quality products and sanitation protocols. However, The Lady Code is not liable if a reaction occurs due to our products.

Service Guarantee

At Lady Code, we want you to walk out happy! If for some reason you are not satisfied with your service, please let us know and we will gladly work to ensure your happiness.

If when you get home and are unhappy with you lash application, we would be happy to adjust them free of charge, up to 2 days after the initial application.

Cancellation Fee

We value our client’s time. If you need to cancel or reschedule your appointment, simply do so 24 hours prior to your scheduled appointment.

Less than 24 hours will result in a $25 cancellation fee.

Return Policy

Unused merchandise can be returned with a receipt up to 10 days for store credit or exchange.

All make-up sales are final sale.

Payment

Cash, Credit, or Debit. No personal checks.

Referral Program

The first client you refer who schedules a full lash set with us, receive HALF OFF a fill. The second client you refer who schedules a full set with us, receive a FREE FILL!!

Groupon

Please note the following when using your Groupon as well as The Lady Codes Policy.

  • Your Groupon is good for the deal you purchased. There are NO EXCEPTIONS or SUBSTITUTIONS.
  • We are not able to accommodate exceptions for expired coupons. We understand, life happens, which is why we give you 90 days to use your Groupon deal. It is your responsibility to use your deal before the expiration date.
  • If you have an expired Groupon, we honor the cash value towards any service of your choice.
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