Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example: @example.com
Instagram
example: @lashwithmari
Birthday
/
Month
/
Day
Year
Date
Please check any of the following that applies to you
Allergy to adhesives band aid or medical tape
Allergy to surgical glue or nail glue
Seasonal allergies
Eye illness or injury
Blepharitis (inflamed eyelids)
Permanent eye-makeup
Lash Lift
Medication / Birth Control
Major surgery within last 120 days
Pregant
Wear contacts
Other
Have you had a lash lift within the past 6 weeks?
Yes
No
Do you have sensitive or watery eyes?
Yes
No
Sensitive only
Watery only
What position do you sleep?
My sides
My back
My stomach
Is there any medical conditions I should know about? Please list below
Have you ever had eyelashes extensions before?
Yes
No
If no, a FREE consultation will be provided at the beginning of the appointment to achieve your desired set. If you are okay with that, please click yes.
Yes
No
If yes, how long ago AND what set would you previously get?
Please agree to the terms and conditions
I hereby agree to have eyelash extensions applied to my natural lashes and consent to the placement and/or removal of the eyelash extensions by the certified professional.
I understand and agree to the after-care instructions and for any unexpected circumstance that have happened due to not following these instructions are in my own risk.
I understand that in rare occasions there are risks associated with having artificial eyelashes. I further understand that in rare circumstances eye or skin irritation and discomfort may occur.
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 to 3 weeks to keep them full.
I consent to having before and after photos for advertising purposes. I understand that these photos may be posted to social media sites.
I consent to this agreement and eyelash extension application/ removal services.
By booking with me, this means you have read my policies and are agreeing to all my policies.
Name
First Name
Last Name
Date
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Month
-
Day
Year
Date
Appointment
Submit
Submit
Client Signature
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