New Client Consultation Form

Eyelash Extension Service / Policy Consent Form

Modified on July 10th. 2023 / Total 12 Required Questions / Total 4 Optional Questions
This information is to be used for professional services offered by The LaLa Lash only. Your information will be held in the strictest of confidence and not used and/or sold for any reason outside of communication with The LaLa Lash.
Name*

First NameLast Name
Email*
* Email may be used to confirm appointment, send notifications or promotion.
Mobile Phone Number*

Area CodePhone Number
OPTIONAL : Parents / Guardian (*For client who is under 18 year old.)

First NameLast Name
Submission Date*

MonthDayYear
I am over 18 years of age and consent to the agreement and to the eyelash extension application procedure.*

YesNo (Please fill your parents’ or guardian’s name on the top of this questionnaire.)
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and / or removal of the eyelash extensions by the certified professional.*

by checking this box I understand and accept this statement
Have you had any reactions / sensitivities at any time from your lashes? (swelling, itching, redness, dry eyelids, etc)*

YesNo
OPTIONAL : Health History : Please check any of the following that applies to you.

Allergy to adhesives band aid or medical tapesAllergy to surgical glue or nail glueSeasonal allergiesEye illness or injuryBlepharitis (inflamed eyelids)Permanent eye makeup in the past 4 weeksEyelash lift in the past 6 monthsSurgeries within last 3 monthsOther
PLEASE READ AND

UNDERSTAND THE FOLLOWING :
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare cases as part of the eye irritation and discomfort could occur. I agree that if I experience any of these conditions with my lashes, it may be beneficial to have the eyelashes removed. In addition to seek medical attention under my own expense should a reaction occur. Please note if a reaction does occur the extensions, I will not receive a refund for service.*

by checking this box I understand and accept this statement
I understand and consent to having my eyes closed for the duration of procedure and that it is my responsibility to keep them closed and remain still during this time. Procedure time vary.*

by checking this box I understand and accept this statement
It is my responsibility to prepare my eye area prior to arrival. Eyelashes and eye area should be clean, dry and free of mascara, makeup, and oil residue. If I attend my appointment without proper preparation, The LaLa Lash cannot guarantee lasting or satisfactory results*

by checking this box I understand and accept this statement
I understand the cancellation / no-show / late arrival policy as follows. (**By checking these boxes I understand and accept these statements.) :*

Cancellations less than 48 hours will be charged 50% of service to future appointment.If more than 15 minutes late, appointment will be canceled automatically.If I fail to arrive to my appointment and give no notice, I will be billed for 100% of the services cost to future appointment.
I understand the refill policy as follows (**By checking these boxes I understand and accept these statements.) :*

Fill schedule should be scheduled in 2~3 weeks from the previous appointment. A scheduled appointment over 3 weeks from the previous appointment will need to be a New Set.40% of lashes must be remaining to be considered a fill.
OPTIONAL : I give The LaLa Lash to take, publish and reproduce photographs of my eye area, both before and/or after the procedure for advertising, training and other purpose.

YesNo
OPTIONAL : If you have any questions, please feel free to leave them here to discuss upon arrival. If you would like to discuss prior to your appointment, please note that as well and we will be touch.
* No entry limits.
Should be Empty:

Eyelash Extension Service / Policy Consent Form