New Lash Client Intake
Please fill this form out if it's your first time getting lashes at Celebrity Skin
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date
-
Month
-
Day
Year
Date
Please list all medications you're taking:
N/A
Other
How did you hear about us? If from a friend, please type their name in the "other" section:
Google
Yelp
Facebook
Instagram
Other website
Friend
Other
Would you be comfortable with your lash technician taking before and after pictures of your lashes?
Yes
No
Please check off any of the following that apply to you, and if any of the procedures have been done, please list the date of most recent procedure in the "other" section:
Contacts
Allergies
Alopecia
Cancer
Demodex Folliculorum
Non-functioning tear ducts
Lasik surgery
Permanent makeup
Eye lift
Microdermabrasion/chemical peel
Retin-A, Accutane, or any other acne medications
Other
The eyelash extensions you are getting today are temporary and it is normal that they will begin to gradually fall out in the next week or so along with your natural lashes. Please carefully read the after care sheet provided at the end of this appointment to best care for your lashes.
To maintain your extensions, we recommend coming in for fills within the next few weeks. Please make sure to check the options we offer for these returning visits.
Due to high demand and a busy schedule, we recommend booking your fill at the end of your visit to ensure availability!
If you have any questions or concerns, please make sure to talk to your technician at the beginning of your appointment.
I hereby agree to allow a licensed technician at Celebrity Skin Chicago to apply lash extensions. To my knowledge, I have no medical condition or allergy which would preclude me from having this procedure done. I agree to hold Celebrity Skin Chicago harmless of any and all medical complications that may arise. I have been advised to discontinue use if any reaction occurs. I have read and fully understand this client release and informed consent form and hereby agree to accept all of the provisions.
Client Signature
Submit
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