Eyelash Extensions Consultation Form
Name
First Name
Last Name
Phone Number
*
-
Phone Number
Email
*
example@example.com
Are you over 18
Yes
No
Previous Lash Experience
Have you ever had eyelash extensions?
*
Yes
No
If yes, did you experience any reactions or sensitivities (such as redness, swelling, itching, watery eyes, or discomfort)?
If yes, what did you like or dislike about the lash set that you had?
Describe the look you would like today (e.g Natural, Wispy, Full glam)
Lifestyle and Habits
Do you wear contact lenses or glasses?
Contact lenses
Glasses
Neither
Please tick any that apply
I use oil based skincare or make up
I regularly swim or use saunas
I sleep on my stomach
I rub my eyes frequently
Medical History and Allergies
Please tick any that apply:
Eye Infections (e.g. conjunctivitis, Blepharitis)
Skin sensitivities or eczema
Allergies to adhesives, latex or cyanoacrylate
Recent eye surgery or treatments
Hay fever or seasonal allergies
None of the above
Is there anything else we should know about?
Informed Consent
Although every precaution will be taken to ensure your safety and well-being before, during and after your lash extension application, please be aware of the following information and possible risks. Please Initial.
I understand that a full set of lash extensions can make the appearance of my own lashes about 30-50% thicker, and make my lashes appear 20-50% longer.
*
Initial
I understand that this is a semi-permanent procedure, as my natural lashes will continue to grow and fall out normally, making touch-up or “refill” appointments necessary to maintain the original look achieved by replacing the lashes that have fallen out. Most clients require a fill appointment every 2-3 weeks.
*
Initial
We would love to snap your lashes for content - but only if you are comfortable! No pressure at all would this be ok?
Yes
Yes, if my face is not shown
No thank you
Please take a photo of your face so we can map your lashes and create the look you desire.
Have you had a patch test 24-48hours before having your appointment?
Yes
No
If no, are you happy to go ahead with your appointment?
Yes
No
Submit
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