Client Consent Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Have you had lash extensions done before?

Have you experienced any allergic reactions or irritation to any lash products?

If yes, please specify

Are you currently experiencing and eye infection or irritation?

Are you currently involved in any activities that may expose your lashes to excessive moisture such as hot yoga or swimming?

Do you have any of the following skin conditions?

How did you hear about us?

On a scale of 1-10 how full do you want your lashes?

**I declare that I have read this consultation form thoroughly and I understand every question asked. I
believe I have no medical condition that may affect the treatment. All of the given answer is correct and
true to the best of my knowledge. I am allowing Klarisa Perez to apply lash extensions to my lashes and understand that there are risks associated with the lash application and or removal including but not limited to irritation/discomfort.

Signature