Client Intake Form for Lash & Wax Services

Client Intake Form

Provide your details to schedule your appointment and help us serve you better.
Full Name

First NameLast Name
Gender
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Appointment Date

MonthDayYear
Date
Do you have any allergies or sensitivities?

Other
Do you have any of the following conditions? If yes, please select them:

Other
Do you have any skin conditions or concerns we should be aware of?
Additional Notes or Questions
Are you currently on any medications? If yes, which medications?
Have you undergo any surgeries? If so, which ones?
Which beauty or cosmetic products are you currently using?
Have you been waxed before? If not, when was the last time you shaved.
Skin condition

Other
Are you pregnant?
Do you consume alcohol?
Signature
Should be Empty: