Client Intake

Name

Date

Address

Birthday

City

State

ZIP

Phone

Format: (000) 000-0000.

Email

example@example.com

Occupation

How did you hear about us?

Is this the first time you have had lash extensions applied?

If no, where have you had them applied?

Are you having lash extensions applied for

Do you wear contact lenses?

Do you habitually rub, pull, or pick your lashes for any reason?

Do you have, or are you being treated for any eye illness or injury?

Are you able to keep your eyes closed and lie still for up to 2 hours or longer?

Please check off any of the following that might apply to you

*Note: Your privacy is Important to us. We will not sell or share your personal information with third parties, unless required by law. Clasmine Christensen

**Please Initial

I understand that this procedure requires and it's my responsibility to keep my eyes closed and be still during the entire procedure. Please no company during appt. (classic individual or volume fan) on a single natural eyelashsynthetic eyelashes to be glued on to my own natural eyelashes using the very precise application of placing an extensionlifting solution and/or tint applied to my own natural eyelashes,

I am informed of potentially harmful or negative side effects that may be caused by the application or removal and release the Lash Technician from all liability associated with this procedure.

I understand that some risks of this procedure may result in, but not limited to, eye redness and irritation. The products used may release fumes and can cause my eyes to water. If any unusual symptoms, injury or allergy is suspected, all future appointments will cease until cleared by your physician.

I understand that my card on file serves as a deposit for this appointment and if unable to make it 50% of payment will be due (24 hour notices are exempt)

I agree to disclose medical conditions including skin conditions and/or any allergies that I may have to latex, surgical tapes, cyanacrylate, etc. if yes, list:

During the first 24 hours following every lash procedure/application, I agree to avoid: wetting the lashes, swimming steam from showers, saunas and tanning beds. While wearing extensions, I will follow the aftercare instructions given especially, daily cleansing.

During the first 24 hours following every lash procedure/application, I agree to avoid: wetting the lashes, swimming pools, steam from showers, saunas and tanning beds. While wearing extensions, I will follow the aftercare instructions given to me, especially, daily cleansing.

Arriving late will reduce the time of service. If I am more than 5 minutes late, I understand my appointment may be rescheduled and will be subject to the no show fee.

If I schedule for a fill, at least 40% of extensions per eye should be in place at the time of my appointment. If there are

I agree to show up to my appointment without any eye makeup. If show up with makeup, it will need to be removed(cleansing fee $30) Extension application time may be reduced due to time spent on removing makeup.

I give permission to "All Lashed Out" to show my before and after photos and/or videos to other potential clients (Facebook, Instagram, website, etc.) Please mark

I consent to having a text message and/or email reminder 24-48 hours before appointment

Please select:

Client Signature

Date

Client Name (Print)

Parent / Guardian (if under 18 years)

Date Sign

Date