Eyelash Extension

EYELASH EXTENSION CONSULTATION & INTAKE FORM

Welcome love! Please complete this form thoroughly to ensure a safe and comfortable experience. ♡
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Emergency Contact Name & Number
How did you hear of LasshedbyLucy? Were you referred ?
EYELASH HISTORY

Please answer:
Have you had eyelash extensions before?
If yes, did you have any reactions or issues?
Details
If you have had eyelash extensions before, is there any eye mapping or lengths in specific you like? Please list anything else in regards to it down below.
Do you wear contact lenses? (please remove them before your appointment)
Do you use any of the following regularly on or near your eyes?
Have you recently had:
Do you have any allergies? If so, please list them below.
MEDICAL HISTORY & HEALTH SCREENING

Please check any that apply:
Medical Conditions
Allergies & Sensitivities
If yes, please explain
Are you currently using or in taking any of the listed below? Check all that apply.
INFORMED CONSENT – LASH EXTENSION SERVICE

Please read and initial each item:
I understand that lash extensions are applied using medical-grade adhesive close to the lash line, but not directly on the skin.
Initial
I understand that there are risks involved, including but not limited to: allergic reactions, eye irritation, temporary eye redness, and lash damage from improper aftercare.
Initial
I agree to follow all aftercare instructions provided and will not rub, pull, or use oil-based products on or near my lash extensions.
Initial
I understand that lash retention varies based on my natural lash growth cycle, skincare routine, and lifestyle habits.
Initial
I understand that fill appointments are recommended every 2–3 weeks to maintain lash fullness and appearance.
Initial
I agree to inform my lash technician of any changes to my health, medications, or sensitivities before future appointments.
Initial
I voluntarily give my consent to receive eyelash extensions and release the technician and salon from liability in the event of a reaction, irritation, or injury.
Initial
I Agree to the Late Policy
Initial
I Agree to the Deposits & Payment Policy
Initial
I Agree to the Cancellation/No-Show Policy
Initial
I Agree to the Fill Policy
WAIVER & AGREEMENT
I agree to have synthetic eyelash extensions applied to my natural lashes by a certified eyelash technician.

I understand the service may take 2–3 hours, during which I will need to remain lying down with my eyes closed.

I understand that I must follow all aftercare instructions to maintain the cleanliness and longevity of my lash extensions.

By signing below, I release LasshedbyLucy and my lash technician from any liability due to allergic reactions or side effects related to the procedure or products used.
I Agree
Initial
Client Signature
Date

MonthDayYear
Date
Should be Empty:

EYELASH EXTENSION CONSULTATION & INTAKE FORM

EYELASH HISTORY

MEDICAL HISTORY & HEALTH SCREENING

INFORMED CONSENT – LASH EXTENSION SERVICE

WAIVER & AGREEMENT