Lash extension consent form template
Screen a client before lashes go on: contact lenses, eye conditions, glue allergies, whether they can lie still, and signed consent to the risks and lash care.
23 questions · about 3 min · logic · e-signature · prefill from the link
- No sign-up to start
- Unlimited responses on Free
Full name
Mobile
Are you under 18?
Which service are you booked for?
Is this your first set of lash extensions?
Have you ever reacted to lash glue, eye pads or tape?
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
- +61412555286
- 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
| submitted_at | Full name | Mobile | Are you under 18? | Which service are you booked for? | |
|---|---|---|---|---|---|
| 2026-09-22T09:41:00.000Z | Ella Fitzgerald-Tan | +61412555286 | ella.ft@example.com | No | Hybrid full set |
The first 6 of 44 columns. Export to CSV or Excel, or send each response to Google Sheets, Notion, Airtable, Slack or a webhook as it arrives, all on the free plan. The answers above are made up.
What this form asks, and why
| Question | Why it is there |
|---|---|
| Full name Required | Who was treated. |
| Mobile Required | For bookings and a check-in after the first set. |
| Email Required | Where the lash care sheet goes. |
| Are you under 18? Required | Opens the parent signature for minors. |
| Which service are you booked for? Required | Sets how long to book. |
| Is this your first set of lash extensions? Required | Opens the patch test offer. |
| 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. |
| Do you wear contact lenses? Required | Lenses come out before the glue goes near the eye. |
| Do any of these apply to you? Required | Some raise the chance of a reaction; others leave few natural lashes to bond to. |
| Are you allergic to adhesives, latex, medical tape or cyanoacrylate glue? Required | The product-specific risk: lash glue is a cyanoacrylate. |
| Eye drops, lash serums or creams you use around your eyes | Oils and some serums break down the bond. |
| 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. |
| How do you usually sleep? | Optional. It decides which side gets lighter lashes. |
| Would you like a patch test before your first full 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. |
| Tell us about anything you ticked or answered Yes to Required Only when “Do any of these apply to you?” is Dry eyes, Frequent eye irritation, itching or watering, An eye infection or condition now, such as conjunctivitis or blepharitis, Eye surgery in the last 6 months, including LASIK, Alopecia or recent lash loss, A thyroid condition or Chemotherapy in the last 6 months or “Are you allergic to adhesives, latex, medical tape or cyanoacrylate glue?” is Yes or “Have you ever reacted to lash glue, eye pads or tape?” is Yes | One box after any Yes or ticked condition. |
| Risks Required | Irritation, allergy and infection, and what happens if glue gets in. |
| If my eyes react Required | What to do next if eyes react. |
| Lash care Required | Most early shedding is water, oil or rubbing. |
| Removal Required | Pulling extensions off takes natural lashes with them. |
| Fills Required | Agreed before the first set. Edit the number. |
| May we take before-and-after photos of your lashes for our portfolio? | Optional and separate, for artists who post their work. |
| Parent or guardian’s name Required Only when “Are you under 18?” is Yes | Who signs for a minor. |
| Signature Required | Covers future fills until the answers change. The response is timestamped. |
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. 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.
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.
-
When “Is this your first set of lash extensions?” is Yes
shows “Would you like a patch test before your first full set?”
-
When “Do any of these apply to you?” is Dry eyes, Frequent eye irritation, itching or watering, An eye infection or condition now, such as conjunctivitis or blepharitis, Eye surgery in the last 6 months, including LASIK, Alopecia or recent lash loss, A thyroid condition or Chemotherapy in the last 6 months or “Are you allergic to adhesives, latex, medical tape or cyanoacrylate glue?” is Yes or “Have you ever reacted to lash glue, eye pads or tape?” is Yes
shows “Tell us about anything you ticked or answered Yes to”
-
When “Are you under 18?” is Yes
shows “Parent or guardian’s name”
-
When “Do any of these apply to you?” is Dry eyes, Frequent eye irritation, itching or watering, An eye infection or condition now, such as conjunctivitis or blepharitis, Eye surgery in the last 6 months, including LASIK, Alopecia or recent lash loss, A thyroid condition or Chemotherapy in the last 6 months or “Are you allergic to adhesives, latex, medical tape or cyanoacrylate glue?” is Yes or “Have you ever reacted to lash glue, eye pads or tape?” is Yes or “Can you lie on your back with your eyes closed for up to 2 hours?” is No
shows the “Thanks …, your artist will check a few things first” ending
-
At the end
shows one of 2 thank-you screens: “Thanks …, see you soon”, “Thanks …, your artist will check a few things first”
Make it yours
-
Send it with the booking
Paste the link into your booking confirmation and turn on Email me in the Connect tab, so answers arrive before the client does.
-
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.
-
Set your fill rule
Edit the Fills statement to your own rule, and the “check first” ending to your patch test policy.
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?
The lash extension consent form is one of the consent & release forms. If it is not quite the job, one of these may be.
- Waxing consent form template
For waxing, where the risk is skin-thinning medication rather than the eyes.
- Tattoo consent form template
For a permanent procedure with a blood and infection screen and an age check.
- Liability waiver form template
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.
Updated 22 September 2026.