Consent Form | LynNyx Beauty LLC

Client Information & Procedure Consent Form

LynNyx Beauty LLC

Please fill out the information below.
Check ALL statement boxes.
Sign your name at the bottom.
Click "Consent/Agree/Sign" to book your appointment.

First Name *

Last Name *

Sex/GenderMaleFemale

Age *

Email Address *

Phone *

Choose your Service *

Choose your Technician *

Allergies *

Medications *

Health Conditions *

Agree *I have elected, by my own decision, to have a lash/teeth whitening/lip filler procedure.

Agree *The procedure including nature and purpose has been explained to me before undergoing the procedure.

Agree *I understand any and all aftercare associated with the process of this procedure and intend to follow the aftercare procedures provided to me.

Agree *I understand and acknowledge any risks or complications associated with the procedure as they have been explained to me.

Agree *I have been given the opportunity to ask questions regarding any risks, complications, or benefits associated with the procedure.

Agree *I understand that this procedure must be performed on my natural lashes/teeth/lips and that false lashes/teeth/lips is not advised as a good candidate for the procedure.

Agree *I attest that I am over the age of 18 and I am not under the influence of drugs or alcohol.

Agree *I attest that I am not pregnant or nursing and will disclose if I am pregnant or nursing before each procedure.

Agree *I understand that this procedure is not permanent and that I may need to receive multiple treatments to achieve my desired results.

Agree *I understand that results may vary and that my payments were rendered for the service not for the individual results.

Agree *I agree to inform the technician regarding any discomfort that I may feel during the procedure.

Agree *I attest that I have given an accurate account of my medical history, including any allergies or prescription drugs that I am currently taking or intend to take.

FULL CONSENT AGREEMENT *In agreement below, I attest that I have read and fully understand this consent form and all details from above. By agreeing below, I assume all and full responsibilities for any risks or injuries, losses, side effects damages, that may occur as part of the procedure. I will not hold my technician responsible for any conditions present at the time of treatment but not disclosed that may affect the treatment.

Photo/Video Consent *YesNoDoes LynNyx Beauty have your consent to use any photos/videos of you for promotional purposes on the website or social media?

Signature *