Eyelash Consent form
Eyelash extensions / Lift / Tint
Client Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Is this your first time getting lash extension, tint, lash lift?
Yes
No
Check the following if any of them applies for you.
Allergy
Eye surgery
Permanent eye makeup
Major Surgery (last 120 days)
Alopecia
Drugs that cause hair loss
Regular swimming pool, contact to bleach or chemicals
Other
Please give details.
Date
-
Month
-
Day
Year
Date
Client's Signature
Submit
Submit
Should be Empty: