• Lash History Form

  • Have you ever had eyelash extensions before*
  • Have you ever had eyelash extensions removed?*
  • Have your used under eye gel patches before*
  • Have you had permanent cosmetics applied to your eyes?*
  • Do you wear glasses /contacts/both?*
  • Do you have a tendency to rub your eyes or pull on your lashes?*
  • Do you go tanning ( In salon or outside) or get spray tans?*
  • Are you pregnant? If yes, please discuss this proceedure with your doctor.*
  • Which side do you sleep on?*
  • Do you exercise?*

  • Are you on a special diet?*
  • Do you have an allergy to any of the following : ( please check all that apply)*

  • Have you experienced any of the following:*

  • How would you describe your hair growth cycle?*
  • Please note that some medications used to treat the following conditions may cause hair/ natural eyelash loss. If you are on medications to treat any of the following , please check mark them below: ( Although, these are not medical conditions, birth control and hormone therapy may result in the thinning or loss of natural lashes)

  • Please mark all conditions that apply:

  • Should be Empty: