NEW CLIENTS

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

Email* This field is required.

example@example.com

4

Is this your first time having lash extensions * This field is required.

YESNO

5

Do you use any products on your lashes?* This field is required.

YESNO

6

Do you use any oil base products on your face?* This field is required.

YESNO

7

Do you wear contacts or glasses?* This field is required.

YESNO

8

Do you have frequent irritated, itchy, or watery eyes? * This field is required.

YESNO

9

How do you sleep at night?

Back

Stomach

Side

10

Do you have any of the following:* This field is required.

Allergies to adhesive synthetics

dry eyes

Pregnancy

hypersensitive to adhesives/tape/gel

None of the above

11

Type a question* This field is required.

By signing this consent form, I hereby acknowledge, consent, and agree to all of the following: I have read and understood all booking policies on booking home site. The eyelash extension procedure requires synthetic eyelashes to be glues to my own natural eyelashes. I understand there is a risk at this procedure that may cause redness and irritation due to fumes from the adhesive. I have discussed all allergies that I may have with my technicianI will need to follow the aftercare instructions. Any unexpected circumstances due to not following these instructions are at my own risk. I am allowed 24 to 48 hrs for any removal due to irritation free of charge after that time I will be charged a removal fee of $20. I am also allowed 24 to 48hrs for a free fill for any excessive shedding. I confirm and agree that I wish to proceed with eyelash extension services at your business in my own will

12

Signature* This field is required.