KEANNASLASH: CLIENT EVALUATION FORMS

KEANNASLASH: CLIENT EVALUATION FORMS
By filling out this form, your tech will be able to customize your lashing experience to better suit you, and assist in creating an aftercare plan for your lifestyle. All information will be kept through Client & Tech Confidentiality.

All fields marked with * are required and must be filled.
*Client Name:

First NameLast Name
*Birthday:
Instagram @:
*Emergency Contact:
*Relationship with Emergency Contact:
*Emergency Contact Phone:
LASH HISTORY & COSMETIC IRRITATION/ALLERGY RISKS

With the following information, your tech will be able to evaluate your overall risk of potential irritation towards your chosen service and take extra precautions.
*Have you had Eyelash Extensions, Lash Tinting and/or Lash Lifting done before?

YesNo
If yes, what lash service(s) have you received?
If you received Eyelash Extensions services, how often do you get them done?

Every 2-3 weeksOnce every 1-2 monthsSpecial occasions only
*Are you knowledgeable on how to effectively take care of Eyelash Extensions?

YesNoSomewhat
*Have you experienced any allergic reactions to Eyelash Extensions, Lash Tinting or Lifting?

YesNoI've never had eyelash enhancing services done before
If yes, please specify any reaction(s):
EYE CARE & EYE HEALTH

As much as we'd LOVE to make you extra gorgeous here at KeannasLash, your eye care and health still comes first.
*Do you wear glasses?

YesNo
If yes, how often do you wear them?

DailyOnly when neededRarely
*Do you wear contact lenses?

YesNo
If yes, please arrive to your appointment without your contacts. If you need to wear them to your appointment, please be prepared to remove them prior to your procedure. It is suggested nnot to wear your contacts immediately after your appointment.
GENERAL HEALTH, CONDITIONS, & HABITS:

With your tech being aware of your conditions and habits, she will be able to better look out for your health, and ensure you feel safe and comfortable throughout your entire lashing experience.
*Have you ever had or currently experience any of the following:

AsthmaBack painNeck painShoulder painSocial AnxietyClaustrophobiaSensitive skinPsoriasisEczemaLight sensitivityMigrainesBlepharitisPink eyeWatery eyesDry eyesEye surgeryEye scratchingLash pickingSleeping on your stomachSleeping on your sidePost-pregnancy body achesHormonal imbalancesI don't experience any of the above
*Are you pregnant?

YesNo
If yes, how far along are you?

First trimester (week 1-week 12)Second trimester (week 13-week 28)Third trimester (week 29-week 40)
*Are you taking any of the following:

MedicationVitaminsSupplementsHormonal contraceptionI don't take any of the above
SKIN TYPE & MAKEUP USE

With the following information, your tech will be able to advise an aftercare plan customized to you.
*What is your skin type?

OilyDryCombinationI don't know
*Check all areas where you experience oiliness:

T-zoneForeheadEyelidsCheeksNoseChinNone apply to me
*How often do you wear foundation/concealer?

DailyA few times a weekOnly for special occasions
*How often do you wear eye makeup?

DailyA few times a weekOnly for special occasions
*Do you regularly wear false lashes?

YesNo
How would you describe your lash type?

CurlyShortStraightI'm not sure
Should be Empty:

KEANNASLASH: CLIENT EVALUATION FORMS

LASH HISTORY & COSMETIC IRRITATION/ALLERGY RISKS

EYE CARE & EYE HEALTH

GENERAL HEALTH, CONDITIONS, & HABITS:

SKIN TYPE & MAKEUP USE