Lash Extension
  • Lash Extension

    Client Intake Form
  • Date
     - -
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Please mark any of these following conditions you may currently have:

  • Consent

  • Please check each statement
  • I agree to the following eyelash extension follow ups:
  • This agreement will remain in effect for this procedure and all future follow-ups conducted by the certified eyelash extensions professional, I understand my lash artist will take every preclusion to minimize or eliminate negative reactions as much as possible. I will hold her harmless and nameless from any liability that Amy result from this treatment. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for disscussion to have any questions answered. I understand the procedure and accept the risks, I do not hold the lash artist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the times of this procedure. Which may be affected by the treatment preformed today. I have read and fully understand all information in this agreement. I am over 18 years old age and consent to the agreement and to the eyelash extension application procedure.

  • Should be Empty: