• Client Intake & Consent Form

  • Date of birth

  • Is this your first time getting eyelash extensions?
  • Have you ever experienced an allergic reaction or irritation from any type of product near the eyes? If yes, please specify.
  • Do you wear contact lenses or glasses?
  • Please check any of the following medical or skin condition
  • Please acknowledge the statements below

  • I declare that I have read this intake form and I understand every question asked. I believe I have no medical condition that may affect this treatment. All the given answers is true and accurate. By signing this form, I am acknowledging that I understand the terms of the service as well as information listed above. This agreement will remain in effect for the service, as well. Any future follow ups with the Eyelash technician. I can send to application, touchups, and/or removal services.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: