Client Consultation Form

Personal/Medical History Form

To ensure you receive the most appropriate lash lift and tint treatment, please complete the following questionnaire. All information provided will be kept strictly confidential.

A contraindication is a condition that makes the client unfit for this treatment. Please consult with me before the procedure if you have any of the following:

Not Recommended for Clients Who Are or Have:

• Pregnant
• Styes/Cysts
• Blepharitis
• Chemotherapy
• Skin disease, trauma, cuts, abrasions, burns, or swelling in the immediate area
• Weak lashes (esthetician's discretion on consultation)
• Skin disorders in the general eye area (Dermatitis, Xanthelasma, Syringoma)
• Eye infections such as Impetigo or Conjunctivitis
• Eye inflammation such as Uveitis
• Recent operations around eyes, head, or face or scar tissue in immediate areas
• Watery eyes
• Hypersensitive skin/eyes
• Keratitis (inflammation of the cornea)
• Alopecia (hair loss)
• Trichotillomania (compulsive urge to pull one's hair out)
• Bell's Palsy or any condition that makes closing or opening eyes difficult
• Any disease or disorder that causes shaking, twitching, or erratic movements

Contraindications & Special Care:

• Dry Eye Syndrome
• Glaucoma
• Post-Chemotherapy

Further Contraindications for Client Comfort:

• Claustrophobia
• Hay fever/Rhinitis (eyes may be watery)
• Contact lenses (ensure removal before the procedure)

Please consult with me before the procedure if you have any of the above conditions.

Please check each box to confirm the following statements are true and apply to you. If you are unable to check a box, please inform your technician before proceeding.

If you are unable to check one or more of the above statements, a patch test or additional consultation may be required. Please notify your technician before your service begins.

LASH LIFT & TINT AFTERCARE INSTRUCTIONS
To ensure optimal results and minimize the risk of irritation or complications, please carefully follow the aftercare instructions below:

First 24 to 48 Hours (Critical Period):

• Keep the lashes completely dry.
• Avoid exposure to water, steam, excessive heat, sweat, and humidity.
• Do not use saunas, steam rooms, swimming pools, hot tubs, or receive facials during this period.
• Avoid showering in a way that exposes the eyes to direct water flow.
• Avoid eye makeup and skincare products around the eyes.
• Refrain from using mascara, eyeliner, eyeshadow, or oil-based cleansers and moisturizers near the eye area.
• Do not rub, touch, or manipulate the lashes.
• This can interfere with the lift and tint setting process and may distort the results.
• Avoid sleeping face-down.
• Try to sleep on your back to prevent lashes from being flattened or bent during the setting period.

After 48 Hours:

• Cleanse the eye area gently.
• Use only oil-free, gentle cleansers. Do not scrub or rub the eye area.
  Avoid waterproof mascara and mechanical lash curlers.
• These can weaken or damage the lashes and interfere with the longevity of the treatment.

Additional Notes:

Lash lift results generally last 6 to 8 weeks, depending on individual lash growth cycles and adherence to aftercare guidelines.

Tint may begin to fade within 2 to 4 weeks, especially with frequent cleansing or exposure to sun, heat, and oil-based products.

You may apply a lash conditioning serum or nourishing oil (such as castor oil or a keratin-based formula) to support lash health.

Avoid additional lash treatments for at least 6–8 weeks.

Allow the natural lash cycle to complete before undergoing another lash lift or tint. 

Please read each statement carefully. By checking each box, you confirm that you understand and agree to the statement.