Client Consent Forms — Vivified Beauty & Wellness

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Client Information

Full Name *

Phone Number *

Email Address *

Date of Service *

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Service Type

Select the service(s) you are receiving — at least one required.

Cluster Lashes Individual Extensions Lash Removal Lash Fill

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Health & Safety

Please check any that apply:

Eye infections or irritation Allergies to adhesives or cosmetics Recent eye surgery or conditions Sensitive skin or eyes

If any apply, please describe:

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Consent & Acknowledgment

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Media Release Agreement

Vivified Beauty & Wellness may record, photograph, or film services and events for promotional, educational, or social media purposes. By submitting below, you grant permission for:

My image, voice, and likeness may be used in photos, videos, or other media. These materials may be edited, published, and shared on social media, websites, and marketing materials. I waive any rights to inspect or approve the finished product or receive compensation for its use.

Client Signature (type full name) *

Date

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All Set!

Your consent forms have been received by Vivified Beauty & Wellness. A confirmation copy has been sent to your email address.

See you at your appointment!

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