Yumi Lash Lift Consent

INFORMED CONSENT FOR YUMI LASH LIFT & TINT
Beauty in the Burbs
1. I agree to have a Yumi Lash Lift and/or Yumi Lash Tint applied to my natural eyelashes and/or retouched

2. I understand there are risks associated with having a Yumi Lash Lift and/or Yumi Lash Tint. I further understand
that as part of the procedure, eye irritation, eye pain, eye itching, discomfort and in rare cases eye infection or
blurriness could occur 

3. I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and
consult a physician at my own expense 

4. I understand that even though my technician performed the technique properly, the instruments, tapes,
cleaners, eye gel pads, adhesives and removers used may irritate my eyes or require a physician’s follow-up care

5. I understand and agree to the aftercare instructions provided by my technician for the use and care of my Yumi
Lash Lifted and /or Yumi Tinted eyelashes. No water can come in contact with the eye area until the specified
time given by my technician, 24 hours after application. I will do my part to maintain my Yumi Lash Lift

6. I realize and accept the consequences of failure to adhere to these aftercare instructions may cause the
eyelashes to not stay lifted as long as told. I understand and consent to having my eyes closed and covered for
the duration of the procedure

7. I am informing my technician of the following conditions by marking with a check: 
__ Current use of contact lenses which I agree to remove during application
__ Current use of anything such as oil-containing sunscreen or moisturizers around the eyes
__ Current use of eye drops of any kind, prescription or over wise
__Current allergies or sensitivities to instruments, fumes, tapes, cleaners, eye gel pads, adhesives and removers
that could cause my eyes to water and blink in excess
__ History of recurrent eye or tear duct infections
__ History of dry eyes or Sjorgen’s Syndrome
__ History of Chemotherapy
__ Other medical conditions which would prohibit or compromise the process and retention of Yumi Lash Lift
8. I understand that this agreement will remain in effect for this procedure and all future procedures conducted by
my technician 
9. I read English and understand that this consent agreement is legal and binding. I have read and fully understand
all information in this agreement 
10. I understand there are no guarantees for length of time the lashes will stay lifted 
11. I have been offered the opportunity to have a patch test of the products being used but have decided to go
ahead with the following treatment without the patch test. I accept full responsibility for any reaction which
might occur due to undisclosed sensitivities/allergies 
12. I am over 18 years of age and consent to the agreement and to treatment 
I authorize Katrina Pulido of Kat Esthetics to apply the Yumi
Lash Lift & Tint procedure to my own eyelashes.