Korean Lash Lift Consent & Client Intake Form

Korean Lash Lift Consent & Client Intake Form

Please complete this form before receiving a Korean lash lift service.
Client Information
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method
Emergency Contact Name & Phone

First NameLast Name
Service Details
Have you had a lash lift or lash perm before?
When was your last lash lift?

MonthDayYear
Date
Have you ever had a Korean lash lift before?
Natural lash type
Desired result
Please upload a photo of your current lashes in natural form

Cancelof
Medical and Eye Health Questionnaire
Do you currently wear contact lenses?
Do you have any of the following eye conditions?
Are you pregnant or breastfeeding?
Do you have any known allergies or sensitivities?
Please list any other allergies, medical conditions, or medications we should be aware of.
Skin and Lash History
Have you ever had a reaction to a lash lift, lash perm, lash extensions, or lash tint?
If yes, please describe the reaction
Do you use any of the following around your eyes?
Korean Lash Lift Consent
Korean Lash Lift Consent Information
I understand the nature of the Korean lash lift procedure and have had the process explained to me.
I understand that individual results vary and that no specific outcome can be guaranteed.
I understand that there is a risk of irritation, allergic reaction, or damage to my natural lashes, even when all protocols are followed.
I agree to inform my technician immediately if I experience any discomfort during the procedure.
Photo Consent/MODEL
I give permission for before-and-after photos of my lashes to be taken.
I consent to the use of my lash photos for marketing (social media, website, print), with my identity kept confidential.
Legal Consent and Signature
Legal Consent Statement
Client Name

First NameLast Name
Date

MonthDayYear
Date
E-Signature
Technician Use
Technician Name

First NameLast Name
Date of Service

MonthDayYear
Date
Products / Solution Type Used
Notes / Observations
Should be Empty:

Korean Lash Lift Consent & Client Intake Form

Client Information

Service Details

Medical and Eye Health Questionnaire

Skin and Lash History

Korean Lash Lift Consent

Photo Consent/MODEL

Legal Consent and Signature

Technician Use