New Client Consultation Form

Date

MonthDayYear

Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

E-mail

example@example.com

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How did you hear about me?

If Referral, please list name

If Other, please let me know

Have you had lash extensions before?

If yes, how was your experience?

Do you pull or rub on your lashes frequently?

Do you have Trichotillomania or other hair pulling compulsions?

Can you commit to cleaning your lashes twice daily?

Please check any of the following that apply to you:

If yes, what allergies?

Are you currently pregnant or nursing?

Do you have any medical conditions we should be aware of? If yes, please explain:

Have you ever experienced claustrophobia?

Do you have any specific ideas, styles or preferences in mind for your lashes?

If you have a reference photo, please share:

Consent

I willingly consent to the artificial eyelash application and/or removal by SD Lush Lab. I understand that there are risks associated with having artificial eyelashes applied to and/or removed from my existing eyelashes, and that notwithstanding the utmost care in the application or removal of these products, there still exist risks associated with the procedure and product itself, which include, without limitation, eye irritation, eye pain, discomfort, and in rare cases, blindness when improperly handled.

As part of this procedure, I understand that a certain amount of eyelash adhesive material will be used to attach the artificial lashes to my existing eyelashes. Even though the professional may apply or remove my lashes properly, I understand adhesive material may become dislodged during or after the procedure, which may irritate my eyes or require further follow-up care, at my own expense to prevent damage to my eyes.

I also agree that I will not attribute any liability to SD Lush Lab as a result of this procedure or the use and care of these lashes. I also agree to defend, indemnify and hold harmless SD Lush Lab from any and all claims, actions, expenses, damages and liabilities, including reasonable attorney’s fees which might be asserted against them as a result of my having this procedure performed. I understand that there are no refunds.

Signature

Do you consent to being filmed/photographed?

Eyelash Extension Consultation Form

Lash History

Medical History

Consultation