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Lash extension consent form template

An eyelash extension consent form for before the first set: contact lenses, eye conditions, glue allergies, lying still, and signed consent to the risks and lash care.

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Full name (required)

Mobile (required)

Are you under 18? (required)

Which service are you booked for? (required)

Is this your first set of lash extensions? (required)

Have you ever reacted to lash glue, eye pads or tape? (required)

23 questions · about 3 min · logic · signature · prefill from the link

  • No sign-up to start
  • Unlimited responses on Free

Print it as a PDF Word version

Change the questions in Word, then print.

What you get back

Every response lands in your results the moment it is sent. Turn on email notifications and each one arrives like this, and the same answers become a row in your spreadsheet.

From PulseFormCreator

Subject New response to Lash extension consent

Full name
Ella Fitzgerald-Tan
Mobile
+13125550186
Email
ella.ft@example.com
Are you under 18?
No
Which service are you booked for?
Hybrid full set
Is this your first set of lash extensions?
Yes

and 15 more answers

A sample email with made-up answers.
submitted_atFull nameMobileEmailAre you under 18?Which service are you booked for?
23 Sep 2026 09:41Ella Fitzgerald-Tan+13125550186ella.ft@example.comNoHybrid full set

Export to CSV or Excel, or send responses to Google Sheets, Notion, Airtable, Slack or a webhook. All free.

What happens after someone submits

Set it up once in the Workflows tab, and every answer is in before the client lies down.

  1. Submitted

  2. A client sends the form

    You get the answers by email, with a PDF of the signed consent for the client file.

  3. They ask for a patch test

    Reply from their response in Results to set a time, and their answer comes back into the same thread.

  4. They finish the form

    The thank-you screen can offer a Book a time button for their first fill, with name and email filled in.

  5. They come back for fills

    Their People record keeps every consent they signed, free for up to 1,000 people.

Set this up when you use the template

What this form asks, and why

A lash extension consent form asks about contact lenses, eye conditions and recent eye surgery, glue or tape allergies and past reactions, and whether the client can lie still with their eyes closed. It then records the risks, lash care and your fill rule, with a signature.

The last column shows how often real lash extension consent forms ask for it.

Question Why it is there Real forms
Full name Required Who was treated. 9 of 11 forms
Mobile Required For bookings and a check-in after the first set. 9 of 11 forms
Email Required Where the lash care sheet goes. 9 of 11 forms
Are you under 18? Required Opens the parent signature for minors. 2 of 11 forms
Which service are you booked for? Required Sets how long to book. Our own recommendation
Is this your first set of lash extensions? Required Opens the patch test offer. 6 of 11 forms
Have you ever reacted to lash glue, eye pads or tape? Required A past reaction to glue, pads or tape is the strongest warning sign. 2 of 11 forms
Do you wear contact lenses? Required Lenses come out before the glue goes near the eye. 5 of 11 forms
Do any of these apply to you? Required Some raise the chance of a reaction; others leave few natural lashes to bond to. 4 of 11 forms
Are you allergic to adhesives, latex, medical tape or cyanoacrylate glue? Required The product-specific risk: lash glue is a cyanoacrylate. 8 of 11 forms
Eye drops, lash serums or creams you use around your eyes Oils and some serums break down the bond. 2 of 11 forms
Can you lie on your back with your eyes closed for up to 2 hours? Required A full set means up to two hours flat, eyes closed. A No goes to the artist to check first, not a refusal. 8 of 11 forms
How do you usually sleep? Optional. It decides which side gets lighter lashes. 2 of 11 forms
Would you like a patch test before your first set? Required Only when “Is this your first set of lash extensions?” is Yes A few lashes with the same glue, a day or two ahead. Regulars never see it. 2 of 11 forms
Tell us more, so your artist can plan Required Only when an eye concern or trouble lying still One box after any flag, including a No to lying still. 3 of 11 forms
Risks Required Irritation, allergy and infection, and what happens if glue gets in. 10 of 11 forms
If my eyes react Required What to do next if eyes react. 10 of 11 forms
Lash care Required Most early shedding is water, oil or rubbing. 10 of 11 forms
Removal Required Pulling extensions off takes natural lashes with them. Our own recommendation
Fills Required Agreed before the first set. Edit the number. 6 of 11 forms
May we take before-and-after photos of your lashes for our portfolio? Optional and separate, for artists who post their work. 5 of 11 forms
Parent or guardian’s name Required Only when “Are you under 18?” is Yes Who signs for a minor. 2 of 11 forms
Signature Required Covers future fills until the answers change. The response records when and how. 11 of 11 forms

What we left out

  • A checklist of drugs that cause lash loss. Clients guess at drug classes; the open box lets them name what they take.
  • An indemnity or blanket release. 8 of 11 forms release the salon. That is waiver wording, not consent.
  • Birthday and how they heard about you. Marketing, not safety. Ask on the booking form if you want them.

What 11 real lash extension consent forms ask

How many include each field, from forms organizations use today. Part of the Form Field Index.

  1. Signature 11 of 11
  2. Acknowledges the risks 10 of 11
  3. Agrees to follow the aftercare 10 of 11
  4. Client's name 9 of 11
  5. Email address 9 of 11
  6. Phone number 9 of 11
  7. Allergy to lash glue, tape or latex 8 of 11
  8. Consent statement 8 of 11
Read September 2026 · US 10, Canada 1 · Sources
  1. Polished Hair Nails Waxing · salon and beauty bar, US
  2. Allure Studio · permanent makeup and lash studio, US
  3. Spa at the Madison · day spa, Canada
  4. Honey Skincare Studio · skincare studio, US
  5. Alison Andrews Day Spa · day spa, US
  6. Hair Expressions Salon and Spa · salon and spa, US
  7. Ultimate Touch Spa · day spa, US
  8. Glam Lash · lash and esthetics studio, US
  9. Natural Finish Lash Extensions · lash studio, US
  10. The Lash Assignment · lash studio, US
  11. The Art of Lashes · lash salon, US

How the form changes as people answer

Most people see a shorter form. These questions and screens only appear when an answer calls for them.

  1. When “Is this your first set of lash extensions?” is Yes

    shows “Would you like a patch test before your first set?”

  2. When an eye concern or trouble lying still

    shows “Tell us more, so your artist can plan”

  3. When “Are you under 18?” is Yes

    shows “Parent or guardian’s name”

  4. When an eye concern or trouble lying still

    shows the “Thanks Ella, we’ll check a few things first” ending

Make it yours

  1. Lift and tint clients

    Pick “Lash lift and tint” above the preview for lift solution and tint wording, without fills or removal.

  2. One link per artist

    Add ?artist= and a name to each artist’s booking link. It is stored with the response as a hidden field.

  3. Set your fill rule

    Edit the Fills statement to your own rule, and the patch test timing to yours.

Good practice and the law

This is general information, not legal advice. Rules differ by country and state, so check anything important where you operate.

  • Australia

    Health information is sensitive information: collect it only with consent and only when the service needs it. OAIC, APP 3

  • UK

    Eye and health answers are special category data: a salon needs a lawful basis and an Article 9 condition. ICO, special category data

  • US

    HIPAA covers health plans, clearinghouses and providers that bill electronically, which a lash studio generally is not. CMS, HIPAA covered entities

Questions about this template

Do I need a patch test before lash extensions?

For a first set it is the simplest check, and the form offers one. Returning clients are not asked.

Can I wear contact lenses for lash extensions?

Yes, but they come out before the appointment, because glue fumes and eye pads can get under a lens. Bring your glasses.

Is a lash consent form a medical record?

No. It is your screening and consent record, and PulseFormCreator is not HIPAA compliant, so keep clinical notes elsewhere.

Why does the form ask how I sleep?

Extensions shed faster on the side you sleep on, so your artist may choose lighter lashes there. The question is optional.

Which form do you need?

Not quite the job? One of these may fit, or browse all release and consent forms.

  • Waxing intake form

    For waxing, where the risk is skin-thinning medication rather than the eyes.

  • Tattoo client consent form

    For a permanent procedure with a blood and infection screen and an age check.

  • Waiver form

    When you also want release wording, where the law allows it.

Start with the lash extension consent form template

Add your fill rule and lash care link, and send the form with every first booking.

Use this template

By , founder of PulseFormCreator. Updated 23 Sep 2026.