No Sign NEW CLIENT LASH EXTENSION INTAKE FORM SHORT

LASH EXTENSION INTAKE FORM NS

By: Vea Modequillo
Important notes:

Please read my policies on my instagram highlights @Veyatelier

Cash is the preferred payment method for paying the rest of your appointment. Please bring appropriate Cash amount as I may not have change, Thank you x

You must be able to sit back and relax for 2-3 hours depending on the set and how many lashes you have (more lashes longer it will take). Please ensure you use the bathroom prior to coming to your appointment. Arrive on time and with a clean lashes/makeup free If you wear contacts please bring glasses as I will not be able to lash you with contacts in. feel free to bring headphones to listen to music, wear comfortable clothing and be prepared to take a nap :)
To book an appointment a $30 deposit is required to secure your appointment. If you are paying Cash you dont need to pay deposit and you can bring the full amount in Cash on the day however if you cancel/reschedule within 24 hours (1 day) of your appointment you will need to pay the $30 Cancellation fee. Please pay deposits/cancellation fees via PayID or Bank Transfer.

Cancellations within 1 day (24hours) of your upcoming appointment will forfeit the deposit. Cancellations must be made within 2 days (48 hrs) of upcoming appointment in order to have the deposit refunded or rescheduled if deposit has been paid. If you chose to pay cash without sending a deposit and cancel/reschdule, you will be charged a $30 cancellation fee. Fees must be paid in order to book in the future or you will be blocked, blacklisted & reported

Location will be given after forms are signed and booking is confirmed.

AVOID CAFFEINE/ENERGY DRINKS/PRE WORKOUT PRIOR TO APPT

PARKING: Please avoid parking in the driveway, there is parking directly opposite to my house or on the nature strip infront of my house
FEES - please refer to booking site under "FEES"

Out Of Hours Fee (Applies To Lash Extensions Only) (before 8am) (6pm+) $10 (listed sets in booking site)

Cancellation Fee $30 (Within 24 hours/1 day or on the day)

Public Holiday Fee ($20) Applies to all public holiday appointments
If you have extreme lash fall out within 3 days of your appointment a free fill may be scheduled. Please notify me immediately as anything after 3 days will result in paying full price for a refill
Note: I do not rush. Appointments can take anywhere from 2-3 hours depending on the set and how many natural lashes you have so please be patient and allocate enough time.

Please turn your phone on silent, refrain from opening your eyes while laying down and try to minimise talking while laying down to ensure appointments run smoothly.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email *
example@example.com
Allow us permission to use your email for exclusive discounts and updates*

AgreeDisagree
Instagram or Facebook
For contact purposes
Emergency Contact

First NameLast Name
Emergency Phone
Please enter a valid phone number.
Medical History
Any previous adverse reaction to a beauty treatment? if none leave blank
if yes please explain
Allergic to any beauty product/ingredient you know of? if none leave blank
e.g Cyanoacrylate, Latex, Acrylic, Medical tape, Methyl, Castor oil, Coconut oil
Any medical conditions that may interfere with treatment(s) today? if none leave blank
if yes please explain
Are you on any medication? Please list any medications/supplements you take regularly:
Thyroid medication, Hair growth supplements etc
Are you wearing contacts or glasses? Contacts must be removed prior to lash extension treatment *
Do you have any of the following conditions or do any of the following? If yes please select them:*

AllergiesAlopeciaCancer/ChemoBlepharoplastyBlepharitisChildbirth within 120 daysConjunctivitisDiabetesDry eyesEczemaGlaucomaPermanent eye makeupPsoriasis around the eyesRosaceaThyroid diseaseRecent eye infectionSensitive eyesCurrently PregnantEye irritation, itching or watery eyesSmokeSick/Flu/Covid/Close Contact/Cough/Cold/ Anything infectious (if yes please do not book until you are well!!)Infectious Diseases (Spreadable by contact/bodily fluids/airborne diseases)Eye illness or injuryStyeNONEOther
By signing below I agree to inform any staff member performing any treatment if I experience any sort of pain or discomfort during any treatment. I also understand that specific treatment's cannot be performed under certain medical conditions and I affirm that I have disclosed any medical conditions necessary, and all answered questions honestly. I agree to update VEYATELIER with any contraindications/conditions, if necessary prior to any treatment performed and understand there shall be no liability on VEYATELIER, their owners, staff, suppliers or business partners, If I fail to do so. I understand that any staff member reserves the right to refuse to perform any treatment on any client who they deem has any sort of contraindication/condition that will interfere with the treatment and my safety as a client. I also take full responsibility for any adverse effects from any treatment(s) performed from today's date and any future treatments performed
Date*

MonthDayYear
Date
Are you currently sick(covid/flu/cold/cough) have symptoms or a close contact? Yes/No*
Patch test
Please read & tick all statements*

I understand that there are risks associated for having eyelash extensions applied to and/or removed from my natural eyelashes.I confirm that my lash technician has explained all the reactions, sensitivities and risks to me and I have been given the opportunity to ask questions.I accept full responsibility for any risks, reactions and sensitivities which may occur and I have disclosed all allergies to my lash technician.My provider has given me the option of patch test, I understand that declining a patch test may result in reactions.I understand and agree that if I experience any reaction that I will contact my lash technician immediately for a removal procedure. If symptoms persist I must seek a medical treatment at my own expense.I will not hold my lash technician responsible in any way for my reactions and sensitivities that might occur.
Please choose an option*

I consent to have a paid patch test done ($5)proceed without a patch test
Please do not proceed with the lash extensions if you experience any adverse reactions including itching, stinging, burning or swelling within 24 hours of your patch test. This is an indication that you may have a sensitivity or allergy. If any reaction occurs please contact me for a removal and see a GP.
Client Consultation Form
Have you ever had lash extensions before*

YesNo
If yes how long ago?
Weeks, days, months, years. (If you have lash extensions on please book a removal before a full set, preferably the day before)
What style did you have in the past, List Set/Sizes/Style/Map if you know
Classic, Hybrid, Volume, Extreme Volume
Is there anything you didn't like about your past extensions
Early lash loss, not enough volume, allergies, too long...
Skin type

Oily skinCombinationNormalDry skin
What side do you normally sleep on?*

LeftRightStomachBack
State of natural lashes? Please select all that apply.*

Normal/HealthyThinGappyShortLongWeakCurlyStraightOther
Desired Length?

Same as natural lashSlightly longerVery longLet Vey DecideOther
What curl would you prefer? (Please note 3D & 5D is only available in D Curl (specialised sets like Aeri use C & CC curl as the base and D/CC curl spikes)

D curlC curlCC curl (limited availability)I don’t mind, let vey decideOther
Desired Coverage/Fullnes

NaturalMediumVolumeFull VolumeExtreme VolumeOther
Would you like a quiet appointment (quiet & relaxing)

YesNoI don’t mind either one
Do you do any of the following to your lashes

Curl (Lash curler)TintPerm (Lash lift within the past 6-8 weeks)Other
Photo Consent & Release Form
Before & After photos are compulsory part of our lash technician records. (You may opt out for marketing/social media purposes)
I consent to photos being taken for personal progress, education, social media & marketing*

YesNo
I consent to photos being posted online for social media & marketing*

YesNo
By signing, I agree to the following
- I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments usually recommended about every 2-3 weeks to keep them full. (if you want)
- I understand the aftercare instructions.
- I understand to keep my eyes closed and be still throughout the treatment process until my lash tech addresses me to open my eyes.
- I understand there may be some risks to this procedure and may be but not limited to eye redness & irritation. The fumes from the adhesive may cause my eyes to tear up if I open my eyes
- I hereby release any and all persons representing this salon from all claims, demands, damages, actions and cause of action arising out of the performance of the service
- I understand to disclose any medical condition/contraindication & allergies that may interfere with the service (contact lenses, latex, surgical tape, cyanoacrylate, vaseline etc)
- I understand that due to the nature of the service provided to me including time and products applied cannot be reused therefore is 100% non-refundable
- I consent to images on social media (if ticked yes on photo consent release form)
I certify that I completely understand and comply with above stated*

YesNo
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LASH EXTENSION INTAKE FORM NS

Medical History

Patch test

Client Consultation Form

Photo Consent & Release Form

By signing, I agree to the following