New Client Form

Name*

Number*

Email*

example@example.com

Birth Month & Date*

Date

Referred by / discovered us by*

Is this your first time having professional eyelash extensions?*

Are you allergic or sensitive to: (write yes or no)

Cyanoacrylate*

Latex*

Surgical Tapes*

Topical creams*

Other*

Have you ever had or currently have: (write yes or no)

Alopecia*

Blepharitis*

Current Irritation*

Pink eye*

Dry eye*

Eye sties/sores*

Sensitive Skin*

Recent eye surgery*

Thyroid Disease*

I understand that lash extension and lash lift services have some risks, which are inherently unknowable prior to initial application, such as allergic reactions, eye irritation and/or redness that may occur and that I need to remain still with my eyes closed for the duration of the application*

Write yes or no

I understand that the eyelash extensions will be applied to my natural lash in a weight and length that best achieves my desired look while preserving the health and growth of my natural lashes*

Write yes or no

I understand that this is a semi permanent procedure. My natural lashes will continue to grow and normally requiring a "fill" to maintain the original look by replacing lashes that have fallen/grown out (approx. every 2-3 weeks).*

Write yes or no

I have received, understand, and will follow the aftercare procedure. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelash extensions to fall out and/or decrease the time the lashes will last. *

Write yes or no

I have chosen to have a patch test.*

Write yes or no

Cancelation/No Show Policy: Your appointments are very important to The Lash Lady; they are reserved especially for you. We understand that sometimes schedule adjustments are necessary; therefore, we respectfully request at least 24 hours’ notice for cancellations. Please understand that when you forget or cancel your appointment without giving enough notice, we miss the opportunity to fill that appointment time, and clients on our waiting list miss the opportunity to receive services. Less than 24-hour cancellations and no shows will result in a charge equal to 50% of the reserved service amount.

I have read and agree to The Lash Lady's cancellation policy*

Write yes or no

I hereby release any and all persons representing this salon from all claims, demands, damages, actions and cause of action arising out of the performance of the services.

(sign)*

(date)*

Date

(parent or guardian if client under18)