EYELASH EXTENSIONS Appointment Form

EYELASH EXTENSIONS APPOINTMENT FORM

Fill the form below and I will get back soon to confirm your appointment. 50% "BOOKING FEE" WILL HOLD YOUR APPOINTMENT and it will be credited towards the service cost. "BOOKING FEE" ARE NON-REFUNDABLE. (Please read Cancellation Policy before booking).
Full Name
Gender
Phone Number

Area CodePhone Number
Date of Birth

DayMonthYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address
example@example.com
Where did you hear about us?
Occupation (Required):
PLEASE READ CAREFULLY AND ANSWER EACH SECTION
Check any of the following allergies that apply (Required):
Choose your Dream Lashes:
Desired Appointment Date: (50% "BOOKING FEE" WILL HOLD YOUR APPOINTMENT and it will be credited towards the service cost. "BOOKING FEE" ARE NON-REFUNDABLE. (Please read Cancellation Policy before booking).
I can confirm that all the information provided by me, is correct and truthful.

I understand that there are no refunds for cosmetic procedures.
Client Signature (required):
Client Printed Name (required):
Date (required):
MEDIA RELEASE CONSENT: For the purpose of documentation, advertising, record and use in portafolio, I CONSENT to the taking of "before" and "after" photographs of my procedure.
Client Signature (required):
The treatment is performed at my request according to this consent, pre-procedure form and post procedure guidelines. All services rendered at Shalom Ink are NON-REFUNDABLE. I hereby authorize Shalom Ink Techncian, to perform Eyelash Extensions procedure on me.
Client Signature (required):
I understand all that I have read all of the above and commit to abide by the instructions given to me by Shalom Ink. (Signature required):
Date (required):
Please type your name initials below:
(FOR LASH FILLS ONLY), PLEASE SUBMIT A PICTURE OF YOUR EYELASH BEFORE BOOKING!

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EYELASH EXTENSIONS APPOINTMENT FORM

PLEASE READ CAREFULLY AND ANSWER EACH SECTION