New Client Appointment Request Form

1
Full Name* This field is required.
First Name
Last Name
2
E-mail* This field is required.
3
Phone Number* This field is required.
Area Code
Phone Number
4
Prefered method of contact?* This field is required.
Email
Phone
Either
5
We have multiple location options? Please select a location you are most likely to receive services?
Columbia, Maryland
York, PA
Mobile (we will come to you)
Other
6
Address* This field is required.City, State, and Zip Code are only required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Disclaimer

VIP appointment services are tailored to each client and require additional fluctuating fees such as travel and/or salon fees. These fees are already included in VIP Price Menu. Mobile visits prices are only a starting price point which may vary depending on customers requested location.
8
Is this inquiry for a upcoming special occasion?* This field is required.This will let us know what supplies and tools to have prepared prior to requested reservation date
YESNO
9
What type of occasion are you requesting services for? We recommend new clients to take a strand test 2-3 days prior to full application reservation date to eliminate any discrepancies that can disrupt normal plans day of an occasion.
Wedding / Bridal Party
Birthday
Anniversary
Holiday
Party / Vacation
Photo / Video Shoot
Baby Shower / Gender Reveal
Other
10
Are you currently or have you ever experienced any of the following below? Check all that apply.* This field is required.
None
11
Have you ever had Semi- Permanent Individual Eyelash Extensions before? * This field is required.
YESNO
12
Did you have or have you ever experience a allergic reaction to lash extensions?* This field is required.
YESNO
13
If yes, please briefly describe what caused the reaction.
14
Are you allergic to any of the following, please select all that apply:If you are allergic to any of the following materials or tools listed below, it may be a possibility that you can not receive services with us.
Adhesive
Tape
Sensitive Tape
Metal
Synthetic Hair Fibers
Mink Hair Fibers
No Allergies
Other
15
Would you like a brief lash education to gain better knowledge of what we offer?* This field is required.
YESNO
16
Image Field
17
Image Field
18
Lash Styles Lash styles that can be applied to any lash technique and/or method.
19
Please choose your desired technique?* This field is required.Prior to service your Lash Artist will give you their professional opinion on what technique would be best suitable for not only your natural eyelash health but to uniquely pair you with a full set during the consultation. Ultimately it is still your choice.
Classic
Hybrid
Volume
Mega Volume
Russian Volume
20
Select your desired lash style.Your Lash Artist will give you their professional opinion on what style would be best suitable for your eye shape during the consultation prior to service.
Cat Eye
Doll Eye (Popular)
Open Eye
Natural Eye
21
To the best of your knowledge, please check all that best describes your natural lashes.* This field is required.
Full
Sparse / Gaps
Thin
Thick
Short
Long
Curly
Straight
Brunette
Blonde
Black
Brown
Ginger
Red
22
Preferred Stylist * This field is required.
Chan - Top Stylist/Technician
Please Select
Any Graduate
Any Stylist
Any Top Stylist
Any Senior Stylist
Chan - Top Stylist/Technician
23
Desired Appointment Date* This field is required.
24
Other details you may wish to highlight
25
Add me to your mail list* This field is required.
Yes please
No, thank you
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