Lash Extension Consent Form

1
Name* This field is required.
First Name
Last Name
2
Contact Information * This field is required.You will receive confirmation of your appointment(s) as well as reminders 24 hours before each appointment.
Please enter your cell phone
3
Birthday
Month
Day
Year
4
How did you hear about LHL & Esthetics ?
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Have you had lash extensions before?
YESNO
6
Do you have lash extensions on now?
YESNO
7
Do you wear glasses?
YESNO
8
Do you wear contact lenses?
YESNO
9
Any recent surgeries, scars or infections? If you have had or will be having any eye surgeries we recommend at least 3 months after surgery before getting extensions. Unless confirmed it is ok by your doctor. This is for your safety and to prevent reactions. Leave blank if no.
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Are you using any lash enhancing serums?Please list which ones if so. Leave blank if no.
11
Do you have any allergies that effect your eyes or skin?If so, please explain. Leave blank if no.
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Do you have any allergies to medications, creams, adhesive tape, latex ect.?If so please explain. Leave blank if no.
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Please list any medications you have taken in the last 30 days.Certain medications can effect lash extension bonds. Leave blank if no.
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Please list any other medical conditions that you think we should know about.
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15
What look do you desire?Let us know what look you most desire.Please know that this does not always mean you’re lash tech can do the look you would like. They can guide you in the direction that is best suited and healthiest for your lashes. This will provide a good idea of what you like so the lash tech can try to achieve it or something similar.
Classic full set
Hybrid full set
Volume full set
I am unsure & would like to consult with my lash tech.
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* This field is required.Lash Extension Booking Policy
17
* This field is required.Cancellation, No-Show and Tardiness Policy
18
* This field is required.After Care Instructions and Maintenance
19
* This field is required.
20
* This field is required.Refund Policy
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Today's Date* This field is required.
22
Signature* This field is required.
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