Lash Lift

Lash Lift
PERSONAL DETAILS:
Name

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Address
Date of Birth

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Phone Number
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Email
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PREVIOUS DISCOMFORT, STINGING OR ADVERSE REACTIONS: Please click any that apply:
Allergies to acetone

Skin DisordersInflammation of the skinEye DiseaseEye infectionsWatery eyesBell's PalsyPrevious reactions to eye treatmentsAllergies to Latex/band aidsAllergies to glue/bonding agents/adhesivesAre you pregnant/lactating?Are you on the contraceptive pill?Are you taking HRT?
Any medications
Other relevant information
Have you had Lash or brow tinting, Lash Lifting, Lash perming, Eyelash extension or semi-permanent mascara applied previously?

YesNo
AGREEMENT: I request and consent to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the products.I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services(s
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Date

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BEAUTY PROFESSIONALS NOTES
Treatments being performed
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