Lash Extension Consent & Liability Waiver

Date

MonthDayYear
Date
PLEASE TAKE A MOMENT TO ANSWER THE FOLLOWING QUESTIONS
ARE YOU CURRENTLY TAKING ANY MEDICATIONS

YESNO
IF YES, PLEASE LIST
ARE YOU PREGNANT

YESNO
DO YOU HAVE ANY ALLERGIES TO COSMETICS, FOOD, OR DRUGS?

YESNo
IF YES, PLEASE SPECIFY
DO YOU TAKE / USE ACNE MEDICATION

YESNO