Eyelash Extension Consent Form

Information you will need

• CLIENT ONLY: What's your name?
• What's your mailing address?
• What's your phone number?
• How did you hear about the company?
• Is this your first time receiving extensions?
• Why are you receiving extensions?
• Do you curl your eyelashes?
• Do you perm your eyelashes?
• Do you tint your eyelashes?
• Do you rub, pull, or pick your lashes?
• Do you have an eye injury or illness?
• What side do you sleep on?
• Can you lie still your eyes closed for multiple hours?
• What eye drops or medications do you use?
• Are you allergic to adhesives?
• Have you had chemotherapy in the last six months?
• Do you take thyroid medication?
• Have you had LASIK surgery in the last four months?
• Have you had eye conditions or surgeries in the last six months?
• Do you have oily skin or hair?
• Do you have seasonal allergies?
• Have you used growth serums or conditioners in the last four weeks?
• SERVICE PROVIDER ONLY: What's your company's name?
• SERVICE PROVIDER ONLY: What's the technician's name?

…and 7 more fields in the PDF.

Completed by the client.

The form includes 3 signature lines.