Soul Tribe Intake Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Birthday
*
-
Month
-
Day
Year
Date
How did you hear about us?
*
Google Search
Social Media
Soul Tribe (Client Referral)
Facebook
Youtube
Other
How do you prefer we contact you regarding important studio updates such as inclement weather closures, etc.? Check all that apply.
*
phone
email
text
If a referral, tell us who to thank!
In which industry or field do you work?
What is your favorite Pandora/Spotify station you use to decompress or relax?
*
Health History
Please select and conditions or contraindications that apply:
Eye Infection
Glaucoma
Cyanoacrylate Allergy
OCD
Neck or Back Pain
Light Sensitivity
Silicone Allergy
Blepharitis
Recent Cosmetic/facial procedure
Overactive Bladder
Seasonal Allergies
Corneal Abrasion
Thyroid Condition
Claustrophobia
Trichotillomania
Asthma
Excessive Tearing
Latex Allergy
Skin Disorders
Hyper Sensitivities
Pregnant
Other
Do you have an eye disease, condition, or injury that has affected your hair/lash growth?
*
Please Select
Yes
No
Do you wear contacts or glasses?
*
Please Select
Yes
No
Have you ever had a Lasik procedure?
*
Please Select
Yes
No
Lifestyle
What service procedure are you receiving?
*
Eyelash Extensions
Lash Lift
Tinting
Waxing Service
Threading
Makeup Services
Please select any that apply to your lifestyle:
Hot Yoga
Frequent Swimming
Sauna
Facials/Esthetic Treatments
Cycling
High Heat Exposure
Severe Cold Exposure
What side to you primarily sleep on?
Left side
Right side
Back
Stomach
Skincare + Makeup
Skin Exfoliants
Sunscreen
Moisturizer
Oil Face Cleanser
Makeup Remover
Gel Eyeliner
Pencil Eyeliner
Eyeshadow Primer
Eyeshadow
Mascara
Face Powders
Makeup Setting Mist
How often do you wear strip lashes?
*
Never
Occasionally
Frequently ( 2x a week)
Very Frequently (2-5X a week)
Daily
Have you used a lash growth serum in the last 6 months?
*
Yes
No
If, yes please list which ones
Please list any additional information you feel may be insightful for your service provider.
Back
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Our Policy Agreement
LATE ARRIVALS
We understand that situations arise, in the event of a delay, please notify the studio if you are running late. Clients who are delayed more than 15 minutes past their scheduled appointment may be rescheduled. A new appointment will be scheduled for the first available date. Please note deposits are non refundable on appointments cancelled less than 24 hours in advance per our cancellation policy.
*
I accept the Terms and Conditions.
LATE CANCELLATIONS/MISSED APPOINTMENTS/NO SHOWS
A 24 hr. notice is required prior to canceling or rescheduling appointments online. If a 24hr notice is not provided, paid deposits are non refundable or will result in a fee of no less than 50% of the scheduled service. All fees must be paid prior to the scheduling future appointments. Failure to provide any notice altogether is considered a No Show. Non-compliance and abuse of these appointment policies may result in our right to end services.
*
I accept the Terms and Conditions.
Cell Phones
Please place your phone on silent or vibrate. We strive to provide the highest level of service possible for everyone. This includes being courteous to our neighbors.
*
I accept the Terms and Conditions
DEPOSITS
Deposits are required for all services. Deposits are deducted from the total service amount of scheduled services, and are non refundable when cancelling less than 24 hours in advance. We reserve the right to charge the entire balance for no show appointments or appointments cancelled after appointment time.
*
I accept the Terms and Conditions
SERVICE CORRECTIONS
If any issues or concerns arise after your session is complete, please contact our studio as soon as possible. We will work to resolve them immediately. Any service follow-ups after our 3-day window may incur a charge.
*
I accept the Terms and Conditions
REFILL POLICY
Natural lashes grow & shed on a regular basis. To maintain the health & look our clients natural lashes we adhere to the following guidelines. Lash extension refills are recommended every 2-3 weeks. We reserve the right to deny service to clients with less than 25% retention per eye and a full set application will be required. Please ask about our refill policies.
*
I accept the Terms and Conditions
Marketing Policy
I release the rights to any photos taken before, during, or after the procedure to be use for educational or marketing purposes.
I consent.
I do not consent.
Checkbox
*
I understand that if I have any concerns, I will address these with my technician. I give permission to my technician to perform the selected service.
I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.
I understand that it is imperative that I disclose all of the information requested in the Client Profile/Health History.
Signature
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