Client Consent & Intake Form
Please provide your contact details, treatment preferences, health and allergy information, and consent for photos/videos. Have your payment details ready for authorization.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Treatment Type
*
Please Select
Eyelash extensions
Lash lift
Permanent makeup
Brow wax /tint
Tattoo
Other
Health Questionnaire
Currently pregnant or breastfeeding
Taking any medications
Undergoing medical treatments
Skin conditions (e.g., eczema, psoriasis)
None of the above
Other (please specify)
Please list any allergies (including to products or medications)
Do you consent to photos and/or video being taken for documentation or promotional purposes?
*
Yes, I consent
No, I do not consent
By submitting this form, I authorize SHE:SHE to securely keep my card on file and charge a set fee if I miss or cancel my appointment late, as outlined in the cancellation policy.
*
I have read and agree to the no-show/late cancellation policy and authorize the fee.
Signature (Required)
*
Submit Consent
Submit Consent
Should be Empty: