Eyelash Extension Intake & Consent Form
Email address *
Full Name *
Please include first and last name.
Your answer
Phone # *
Your answer
Appointment Date & Time
MM
/
DD
/
YYYY
Time
:
How did you hear about us? *
If referred, please include name.
Your answer
Is this the first time you have had eyelash extensions applied? *
Do you curl, perm, or tint your lashes? *
Are you having eyelash extensions applied for a special occasion or daily wear? *
Do you wear contacts? *
Do you habitually rub, pull, or pick your lashes for any reason? *
Do you have, or are you being treated for any eye illness or injury? *
What side do you predominately sleep on? *
Please list any eye drops or eye medication you are using:
Your answer
Are you able to keep your eyes closed and lie still for up to 2 hours or longer? *
Please check any of the following that might apply to you: *
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