Consent Form

Consent Form

Eyelashbar
Name

First NameLast Name
Appointment Date

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityUk

Post code
Email
example@example.com
Phone Number
Can we Email You infils Reminder/ special offers-Discount Codes & Giveaways
What Treatment are you having
Patch test for tint or henna required
Have you had lashes before
Patch test required, Too Avoid Allergic Reaction
Patch Test Date - Done

DayMonthYear
Date
Do you wear contacts or glasses?
Are you pregnant or breast feeding?
Any Eye Problem in Last Month?
Any Allergies - such as Latex or other
Asthma / Respiratory problems
I can confirm I have filled out this form to The best of my Knowledge and understand if anything shall change I will inform my lash tech before my next service is carried out.
If you have not had a patch test at least 24 hours before your appointment please be aware you may have an allergic reaction as this can occur before or after 24 hours prior to having your treatment. Please sign underneath the box as a sign of agreement to having the treatment without a patch test with a understanding a reaction may occur. I have also been told by my therapist that this may happen before my appointment was carried out
Signature
Today Date

DayMonthYear
Date
Permission to take pictures and videos for marketing and social media?
Photos will be used on Instagram @eyelashbar.Uk- Follow us
Where you hear about us
This is a fill in the field. Please add appropriate blank fields and text.
I give permission for my daughter to have her lashes done at eyelashbar
Signature
Should be Empty: