NAME *

First Name

Last Name

MOBILE PHONE NUMBER *

OUR LASH ARTISTS COMMUNICATE PRIMARILY THROUGH TEXT MESSAGES.

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ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

BIRTHDAY *

MM

DD

YYYY

HAVE YOU HAD A LASH LIFT AND/OR TINT IN THE PAST? *

YES

NO

HAVE YOU EVER HAD A REACTION TO LATEX OR OTHER SYNTHETICS? *

YES

NO

ALTHOUGH IT IS IMPOSSIBLE TO LIST EVERY POTENTIAL RISK AND COMPLICATION, THE FOLLOWING CONDITIONS ARE RECOGNIZED AS CONTRAINDICATIONS FOR A LASH LIFT AND/OR TINT AND MUST BE DISCLOSED PRIOR TO TREATMENT: *

please check all that apply or none.

CHRONIC DRY EYE

SENSITIVITIES

SEASONAL ALLERGIES

CONJUNCTIVITIS

EYE INFECTIONS/DISORDERS

RECENT EYE SURGERY

TRICHOTILLOMANIA

CHEMOTHERAPY (IN THE PAST 12 MONTHS)

PREVIOUSLY DAMAGED LASHES

NONE

DO YOU GIVE BOSTON LASH PERMISSION TO TAKE AND/OR USE YOUR PHOTO FOR PURPOSES OF DOCUMENTATION, POTENTIAL ADVERTISING AND/OR PROMOTIONAL PURPOSES. *

YES

NO

I AUTHORIZE BOSTON LASH TO PERFORM A LASH LIFT AND/OR TINT. I HAVE READ, UNDERSTOOD, AND STATED ANY ISSUES THAT MAY PREVENT ME FROM COMPLYING WITH THE SERVICE(S) PROVIDED. BOSTON LASH WILL NOT BE LIABLE FOR ANY CLAIM, LOSS, OR DAMAGE INCURRED, MEDICAL OR OTHERWISE, DUE TO OR AS A RESULT OF THE SERVICES THAT I HAVE RECEIVED AT BOSTON LASH. BOSTON LASH RESERVES THE RIGHT TO REFUSE ME SERVICE SHOULD THEY FEEL THE SERVICE WILL NOT BENEFIT ME ACCORDING TO MY INFORMATION ENTERED ABOVE. I RATIFY AND CONSENT TO ALL SERVICES RENDERED AT BOSTON LASH UNDER THESE TERMS. *

I understand this statement

I AM AWARE THAT A LASH LIFT WILL LIFT MY NATURAL LASHES. DEPENDING ON MY NATURAL LASH LENGTH AND STRENGTH, RESULTS MAY DIFFER. I AM ALSO AWARE THAT THE LASH TINT WILL TINT MY NATURAL LASHES BLACK. WHILE EVERY ATTEMPT WILL BE MADE TO ENSURE MY SATISFACTION WITH MY SERVICE, BOSTON LASH CANNOT GUARANTEE THE FINAL RESULT. *

I understand this statement

I KNOWINGLY AND FREELY ASSUME THE POSSIBILITY OF AN ALLERGIC REACTION. IF I EXPERIENCE AN ALLERGIC REACTION TO ANY OF THE PRODUCTS USED DURING MY SERVICE, I WILL CONTACT BOSTON LASH IMMEDIATELY TO ASSESS THE SITUATION. A REFUND WILL NOT BE GIVEN FOR AN ALLERGIC REACTION. *

I understand this statement

IF I CANCEL OR RESCHEDULE MY APPOINTMENT I WILL GIVE 24 HOURS NOTICE OR I WILL BE CHARGED A $50 FEE. *

I understand this statement

I WILL NOT BRING MY CHILD/CHILDREN OR PETS TO MY APPOINTMENT. *

I understand this statement

IF I HAVE HAD A LASH LIFT IN THE PAST 30 DAYS, I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO MAKE BOSTON LASH AWARE OF SAID PREVIOUS SERVICE. *

I understand this statement

I AGREE TO FOLLOW THE AFTERCARE INSTRUCTIONS PROVIDED BY BOSTON LASH FOR THE USE AND CARE OF MY LASH LIFT AND/OR TINT AND THAT BOSTON LASH IS NOT RESPONSIBLE FOR ANY DAMAGE I MAY CAUSE TO MY LASH LIFT AND/OR TINT OR MY OWN EYELASHES/EYES. *

I understand this statement

IF I WEAR CONTACT LENSES, IT IS AT MY OWN DISCRETION TO REMOVE THEM DURING MY SERVICE. *

I understand this statement

IF I AM BREASTFEEDING, PREGNANT OR ARE TO BECOME PREGNANT, I WILL ADVISE MY PHYSICIAN BEFORE RECEIVING ANY SERVICE AT BOSTON LASH. *

I understand this statement

I REPRESENT THAT I AM OVER THE AGE OF 18. IF I AM UNDER THE AGE OF 18, I WILL ARRIVE WITH A PARENT OR GUARDIAN WHO WILL BE REQUIRED TO COMPLETE A RELEASE FORM BEFORE ANY SERVICE IS PROVIDED. *

I understand this statement

BOSTON LASH CARRIES A NO REFUND POLICY FOR SERVICES OR PRODUCTS. *

I understand this statement

ASSUMPTION OF RISK: I HAVE READ AND UNDERSTOOD THE ABOVE WARNING CONCERNING COVID-19. I HEREBY CHOOSE TO ACCEPT THE RISK OF CONTRACTING COVID-19 FOR MYSELF IN ORDER TO UTILIZE BOSTON LASH’S SERVICES AND ENTER BOSTON LASH’S PREMISES. THESE SERVICES ARE OF SUCH VALUE TO ME THAT I ACCEPT THE RISK OF BEING EXPOSED TO, CONTRACTING, AND/OR SPREADING COVID-19 IN ORDER TO UTILIZE BOSTON LASH’S SERVICES AND PREMISES IN PERSON. *

I understand this statement

WAIVER OF LAWSUIT/LIABILITY: I HEREBY FOREVER RELEASE AND WAIVE MY RIGHT TO BRING SUIT AGAINST BOSTON LASH AND ITS OWNERS, OFFICERS, DIRECTORS, MANAGERS, OFFICIALS, TRUSTEES, AGENTS, EMPLOYEES, OR OTHER REPRESENTATIVES IN CONNECTION WITH EXPOSURE, INFECTION, AND/OR SPREAD OF COVID-19 RELATED TO UTILIZING BOSTON LASH’S SERVICES AND PREMISES. I UNDERSTAND THAT THIS WAIVER MEANS I GIVE UP MY RIGHT TO BRING ANY CLAIMS INCLUDING FOR PERSONAL INJURIES, DEATH, DISEASE OR PROPERTY LOSSES, OR ANY OTHER LOSS, INCLUDING BUT NOT LIMITED TO CLAIMS OF NEGLIGENCE AND GIVE UP ANY CLAIM I MAY HAVE TO SEEK DAMAGES, WHETHER KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN *

I understand this statement

CHOICE OF LAW: I UNDERSTAND AND AGREE THAT THE LAW OF THE STATE OF MASSACHUSETTS WILL APPLY TO THIS CONTRACT. *

I understand this statement