New Client Consultation Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date

MonthDayYear

How did you hear about us?

If referral, whom can I thank?

Health History / Please check any of the following that applies to you

Have you ever had eyelash extensions before?

If no, would you like to have a patch test which we highly recommend? (Note that a patch test does not guarantee that an adverse reaction will never happen). If yes, you will need to wait 24 hours to receive your service.

Please agree to the terms and conditions.

Acknowledgement and Waiver

I am over 18 years of age and consent to the agreement and to treatment or have a parent with me that consents to this service. This agreement will remain in effect for this procedure and all future procedures conducted by Debbie Kroh. I read English and understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them.

Signature

Eyelash Extension Consent Form