Full name* Date of Birth* Phone Number* Email* Emergency contact : Full name* Phone Number*
Have you ever had eyelash extensions? Yes No* Have you ever removed or picked off your own lash extensions? Yes No* Do you currently have eyelash extensions on? Yes No*
If yes: Have you ever had an allergic reaction? Yes No*
Are you seeking a fill over another artist's work? Yes No Date of your last fill (if known): Date Have you experienced poor lash retention in the past? Type a label Is there anything you'd like your lash artist to know before your appointment? Type a label
I understand that foreign fills may require additional time, removal and/or a new set. I accept full responsibility for the outcome and do not hold Lashed by Ana liable for previous work done by another artist. I agree
May I use photos/video of your lashes for educational and promotional purposes? Yes, I agree No, do not agree*
I certify that the information provided is true and complete. By signing below, I acknowledge that I have read, understand, and agree to the policies and consent to services provided by Lashed by Ana. This consent will remain on file unless my medical or contact information changes.
Signature* Date*
Electronic signatures are legally binding and carry the same validity as handwritten signatures.
Thank you for taking the time to complete this form. My goal is to provide every client with a relaxing, safe, and personalized experience. If you have any questions before your appointment, please don’t hesitate to reach out.