New Client Form
After submitting and completing the client form please send a $20 NON-REFUNDABLE deposit. If not done before appt, then the appt will be rescheduled. CASHAPP: $JennyzJett
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Appt
-
Month
-
Day
Year
Date
How Did You Find Me?
Instagram
Internet Search
Facebook
TikTok
Referral
Other
If Referral, please let me know the name:
Will you need a lash removal?
Yes
No
If yes, please list date of last lash application:
If you are receiving a removal please indicate if any of the following apply:
Discomfort
Itching
Burning & Stinging Sensation
Swelling
General irritation
Additional Comments or Concerns:
Removal of lash extensions applied at a a foreign studio may expose visible breakage, gaps, thinning, and accumulated damage as a direct result of the original application technique. Badwitch Studios is not responsible for the condition of my lashes post removal.
I understand and acknowledge this policy
Is this your first time receiving eyelash extensions?
Yes
No
Please provide a description of your last procedure. List any helpful details that will allow us to customize your experience. Example: Preferences, expectations, etc...
Photo References Needed
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What procedure are you receiving?
Lash Extension
Consulation
Please select any contraindications that apply:
Eye Infection
Corneal Abrasion
Anxiety/ Panic Attacks
Acrylate Allergy
Glaucoma
Cancer
OCD
Back or Neck Pain
Dry Eye
Eye Sensitivity
Silicone Allergy
Blepharitis
Recent Cosmetic Facial Procedure (Botox, Microblading, Filler, etc)
Pregnant
Breastfeeding
Overactive Bladder
Seizures
Seasonal Allergies
Wear Contact Lenses
Eye Surgery
Please list any medications you are taking:
Other relate health info:
Lifestyle:
Hot Yoga
Frequent Swimming
Active lifestyle
Sauna
Facial/ Esthetic Procedure
Cycling
High Heat Exposure
Crossfit
Skincare + Makeup
Skin exfoliants containing beads, particles, etc.
Sunscreen
Moisturizer
Oil Face Cleanser
Skin Serum
Makeup Remover
Eye Cream
Gel Eyeliner
Pencil Eyeliner
Eyeshadow Primer
Eyeshadow
Mascara
Face Powders
Makeup Setting Spray
How often do you wear strip lashes?
Never
Frequently: 2x a week
Very Frequently: 3-5x a week
Daily
Have you used a lash serum in the last 6 months:
Yes
No
If yes, please list serum:
Do you have a tendency to pick/pull at your natural lashes?
Yes
No
Back
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I have been provided with access to the specified procedure guide and acknowledge the policies within. I have been made aware of the risks associated with my chosen treatment. By consenting, I am waiving any provider liability and agree to hold my provider harmless.
I consent
I do NOT consent
I acknowledge the 48 hour cancellation + rescheduling policy.
I acknowledge
I do NOT acknowledge
I acknowledge that the location of my appt is in Yucaipa, CA (address will be sent through text the night before) and is home based
Yes
No
I understand and acknowledge that the home has pets, but they will be separated from the area of the lash procedure. The home is dog and cat friendly (please let me know if allergic- we can come up with alternative)
Yes
No
Signature
Continue
Continue
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