• Eyelash Extension Intake Form

    Please be sure to fill this out to the best of your ability prior to your appointment.

  • Contact Information

  • Format: (000) 000-0000.

  • Lash History and Health History

  • Is this your first time having Eyelash Extensions?*
  • If this is NOT your first time having eyelash extensions, please provide details that will help us customize your service. Are you/ or have you experienced any of the following when having eyelash extensions:
  • Are you having lash extensions applied for?*
  • How often do you wear makeup?*
  • Do you often rub, pull or pick your lashes for any reason?*
  • Do you have , or are you being treated for any eye illness or injury?*

  • Lifestyle

  • Select any of the following activities in which you participate in:*
  • How do you usually sleep? Please note you will lose more eyelash extensions on the side on which you sleep. Sleeping on your stomach will affect them the most.*
  • Do you wear Contacts? If YES, please be sure not to wear them for your appointment.*
  • Do you have Extremely Oily skin and or hair? Natural oils will break down the adhesives used to bond the eyelash extensions causing the extensions to fall out quicker. This does not mean you cannot have the service, merely it may cause them to fall out quicker.*

  • Beautiful lashes can be serious life-changers!

    Lashed by Nadia uses only high quality products and lightweight lashes to give you a painless and luxurious experience. Here is a breakdown of what will happen at your appointment.


  • Step 1 - Consultation with your lash artist to insure this service is right for you and agree of what kind of lashes you are looking to achieve.


    Step 2 - Get Started with a lash bath and ensure your lashes are free of any oils or debree that may affect retention. Get your bottom lashes taped down and ready to start the application.


    Step 3 - Get Lashed! The whole service should be pain free and comfortable, so if at any moment your feel any buring, poking, or itching be sure to let your lash artist know.

    Step 4 - Admire your beautiful new lashes and address any issues or concerns to your lash artist. If there is anything you are unhappy about or wish to change this is the time to speak up!

    Don't forget to prebook your fills every 2-3 weeks!

  • I grant permission to use my before and after photos for marketing or examples of my technicians work.*

  • Specialist has sanitized hands and implements. I assume full responsibility for myself and anybody in my care. I have notified my eyelash specialist of any and all health complications that I may have.

    I will give a minimum of 48 hours notice for a cancellation so that the specialist can book another client for the time that was reserved. If failed to do so, I agree to pay 50% of the remaining service balance to compensate for the specialist’s time. If I cancel or reschedule the day of my appointment, I will pay 100% of the service missed to compensate the specialist for their time. If I do not call to cancel an appointment and fail to show up to said appointment, I am aware that I will be expected to pay 100% of the service. If failed to do so I understand I will be blocked from booking until I pay the amount owed.

    I understand that in rare occasions, an allergy may occur between myself and the lash adhesive, where irritation, redness, or swelling may take place. If this should happen, I will not hold the specialist who applied my eyelash extensions liable. I am responsible for seeking medial help if needed to.

    For any and every additional eyelash extension appointment I will review these forms and either confirm that the information is still up to date, or I will make my lash technician aware of any changes.

    I understand that to insure the longest lasting lashes possible, I should avoid rubbing and pulling on my eyelashes. I understand that mascara of any kind could break down the lash adhesive, resulting in a shortened lash life. I am aware that the lash adhesive needs at least 24 hours to fully cure and that I MUST avoid water, steam, tears, eye drops, or any wet products in, on, or around my eyes and lashes during this time period. I am fully aware that moisture on my lashes within 24 hours after my eyelash extensions have been applied may result in irritation to my eyes or eyelids and could compromise the appearance and/or the longevity of the lashes. I understand that any products, such as make-up removers, moisturizers, make-up, or eye creams, on or around my eyelash extensions may compromise the longevity of the lashes. If I fail to follow these after care instructions, I will not render LASHED BY NADIA responsible for any dissatisfactory results.

  • Sign date *
     - -
    2 digit month, 2 digit day, 4 digit year
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