Form

Client Intake/Consent Form

In order to provide you with the most appropriate service, we need you to complete the following questionnaire. All information is confidential.
Name
Date
Date of birth
Email or Phone number
How were you referred to me?
Emergency Contact & Phone number
Do you have any medical conditions I should know about?
Do you have any allergies? If yes, please list them.
Do you have allergies to pets?
Are you currently taking any medications?
Are you pregnant or lactating?
Do you have watery or dry eyes?
Do you wear contacts?
Have you had eyelash extensions in the past? If yes, how long ago, and how was your experience with them?
Have you had any allergies to eyelash extensions in the past?
Are you currently using any eyelash growth serums or oils for hair in general?
What is your preferred eyelash set? Please list sizes if you know them.
Do you consent for me to post before & after photos on social media?
Photos are taken for marketing purposes
Do you prefer morning or afternoon appointments?
Do you prefer weekday or weekend appointments?
I AGREE TO HAVE SYNTHETIC EYELASH EXTENSIONS APPLIED TO MY NATURAL LASHES BY A CERTIFIED EYELASH TECHNICIAN.

I UNDERSTAND THAT APPOINTMENT TIME VARIES FROM CLIENT TO CLIENT BUT I AM FULLY AWARE THAT MY APPOINTMENT WILL APPROXIMATELY TAKE ABOUT 2-3 HOURS, WHERE I WILL BE LAID DOWN WITH MY EYES CLOSED FOR THE ENTIRE SERVICE.

I UNDERSTAND THAT IN ORDER TO MAINTAIN MY EYELASH EXTENSIONS CLEAN AND FULL, I HAVE TO WASH THEM WITH EYELASH FOAMING SOAP EVERY DAY AT LEAST ONCE A DAY.

I UNDERSTAND THAT OILS IN MAKEUP, FACE WASH, AND EVEN OILINESS IN FACE CAN EFFECT THE RETENTION OF MY EYELASH EXTENSIONS.

I UNDERSTAND THAT LASHES ARE NOT PERMANENT AND I WILL NEED TO COME BACK IN 2-3 WEEKS FOR A FILL.

I UNDERSTAND THAT IF I HAVE ANY CHANGES IN MY MEDICAL HISTORY, I WILL LET MY EYELASH TECHNICIAN KNOW IMMEDIATELY BEFORE MY APPOINTMENT.

I UNDERSTAND THAT BY SIGNING THIS WAIVER I AM FULLY RESPONSIBLE FOR ANY ALLERGIC REACTIONS AND I RELEASE MY EYELASH TECHNICIAN FROM ANY CLAIMS. I FULLY ACKNOWLEDGE THAT I HAVE READ CAREFULLY AND AGREE WITH THE POLICIES THAT HAVE BEEN SET BY FLAWLESSTOUCH BY CINDY.
Please Print name
Date
Signature

Client Intake/Consent Form