Cluster lash Client Consultation Form

Client Consultation Form

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Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Birthday *

MonthDayYear
Instagram
Example @The.Cosmic.Lash
How did you hear about The Cosmic Lash?*
Have you ever used kiss cluster lash mascara?*
If so how was your experience?
Have you ever used cluster lashes?*
If so how was your experience?
Do you have sensitive skin?*
What is your skin type?*
Do you have any allergies to products/dyes?.*
*If you answered yes to this question please explain in the additional comment section at the bottom of the page before submitting this form!*
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‘I have read & agree to the terms of cancellation’*
The cancellation policy is in the image above as well as on my website (Cosmic-lash.square.site)
‘I read & agree to follow the appointment policies’ *
Appointment policies are in the image above as well as on my website (Cosmic-lash.square.site)
‘I agree & consent to Francesca Amodeo preforming a cluster lash application and do not hold my tech liable for any medical or physical occurrence!’*
*Non liability*
‘I give consent for pictures’*
If you don’t want to be posted just let me know in the comment section!
‘I give consent to the services (cluster lash application) being done by Francesca Amodeo’*
If you are under the age of 16 you must have a parent text/call me to give consent! (631)652-5948
EVERYONE MUST SIGN THIS SECTION *with you’re real signature* unless you are 17 yrs old and younger, then you must have a parent read the policies and sign the form! *
Full printed name of Parent/Guardian/Client signing & consenting*

First NameLast Name
Date*

MonthDayYear
Date
Additional Information/Comments
Should be Empty:

Client Consultation Form

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