Service Waiver  ·  Popular

Screen Lash Clients for Allergies and Collect Waivers

A ready-to-use eyelash extension waiver that screens clients for allergies, confirms patch test status, and records each client's risk acknowledgment.

Cloud theme
formbuilder.ai/f/eyelash-extension-service-liability-waiver-allergy-risk-acknowledgment-form
Eyelash Extension Service Liability Waiver & Allergy Risk Acknowledgment Form
Client Full Name
· · ·
Date of Birth
· · ·
Phone Number
· · ·
Submit

This eyelash extension liability waiver and allergy risk acknowledgment form gives lash studios a complete, professional way to prepare clients before every appointment. It starts by collecting client and appointment details, including date of birth, contact information, the service requested, and the assigned lash technician. A dedicated health and allergy screening section then asks about previous extension experience, past reactions, known allergies or sensitivities, current health conditions, medications, and patch test status. This helps your lash artist decide whether the service is suitable and what precautions are needed.

The template is built for lash artists, beauty salons, brow and lash bars, spas, and mobile beauty professionals who work with cyanoacrylate-based adhesives. Its risk acknowledgment section clearly explains possible side effects such as irritation, redness, swelling, infection, allergic reaction, and weakening or loss of natural lashes. It also reminds clients that reactions can develop even after previous problem-free sets. Clients confirm each statement individually, and parents or legal guardians can complete the form on behalf of clients under 18.

Using a digital waiver helps protect your business, cuts down on front-desk paperwork, and creates a reliable record of informed client consent. The form also asks permission to take before-and-after photos for your portfolio and social media, so you can handle photo consent in the same step. Customize the questions and release language to match your salon policies and local requirements, then share the form by link so clients can complete it before they arrive.

3 Pages
19 Questions
~6min To complete
Free No credit card needed
Field types Date ×3 Yes / No ×3 Multiple Choice ×3 Full Name ×2 Phone Email Dropdown Short Text Long Text Single Choice termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Client & Appointment Details 7 questions
Client & Appointment Details
1 Client Full Name * Full Name
2 Date of Birth * Date
3 Phone Number * Phone
4 Email Address * Email
5 Appointment Date * Date
6 Service Requested * Dropdown
7 Lash Technician Name Short Text
Page 2 Health & Allergy Screening 6 questions
Health & Allergy Screening
Your safety is our highest priority. Please answer the following questions honestly and completely so your lash artist can determine whether this service is suitable for you and whether any precautions are needed. Failing to disclose relevant health information may increase your risk of irritation, infection, or allergic reaction. If you are a parent or legal guardian completing this form for a client under 18, please answer on behalf of the client receiving the service.
1 Have you had eyelash extensions before? * Yes / No
2 Have you ever experienced an allergic reaction or irritation after a previous lash service? * Yes / No
3 Do you have any known allergies or sensitivities to the following? (Select all that apply) * Multiple Choice
4 Do any of the following currently apply to you? (Select all that apply) * Multiple Choice
5 If you answered Yes or selected any allergies or conditions above, please provide details including any current medications Long Text
6 Which of the following best describes your patch test status? * Single Choice
Page 3 Risk Acknowledgment & Consent 6 questions
Risk Acknowledgment & Release of Liability
Eyelash extensions are applied individually to your natural lashes using a professional adhesive that contains cyanoacrylate. Although every precaution is taken, possible risks include eye irritation, redness, watering, itching, swelling, allergic reaction, infection, and weakening or loss of natural lashes. Allergic reactions can develop at any time, even if you have previously worn extensions without any issues. Please read each statement below carefully before signing.
1 Please check each statement below to confirm you have read and understand it * Multiple Choice
2 Do you consent to before-and-after photos of your lashes being taken and used for the salon's portfolio and social media? * Yes / No
3 I confirm that the information I have provided is accurate and complete and that I have disclosed all known allergies and medical conditions. I have read and understand the risks of eyelash extensions and voluntarily consent to receive this service. I release the salon, its owners, and its lash technicians from any liability for allergic reactions, irritation, injury, or damages arising from this service, except in cases of gross negligence. * termsandconditions
4 Parent or Guardian Full Name (if client is under 18) Full Name
5 Date Signed * Date
6 Client Signature (or Parent/Guardian Signature if client is under 18) * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.

  • Ready-to-use structure — pre-configured fields out of the box
  • Applied "Cloud" theme — fonts, colors, and layout already set
  • Mobile-responsive — works on every device without extra configuration
  • Fully editable with drag-and-drop — change anything in seconds
  • Free to use on any plan, no credit card required

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Free to use. Open in the editor, customize, and publish in minutes.

Use This Template Free Preview the form
Category Consent & Waiver
Subcategory Service Waiver
Theme Cloud
Badge Popular
Price Free
Coding required None

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