Lash Up Lace Up LLC

Lash Client Intake/Consent Form

Full Name *

Enter first and last name

Phone Number *

Enter best phone number to send confirmations, reminders and receipts to

Email *

Enter best email to send confirmations, reminders and receipts to

Date of Birth *

Enter your date of birth (i.e. 06/17/1991)

Requested Appointment Time/Date *

Enter your requested appointment time and date.

I have had eyelash extensions done before *

Select yes or no

Allergies or Sensitivities *

List any known allergies (adhesives, latex, etc.) or eye sensitivities

I understand I should not wear mascara or curl my lashes before my appointment *

Please come to your appointment with a clean face, and no makeup on your eyes

Eye Conditions *

Have you had any eye surgery, infections, or conditions in the past 6 months?

I understand there is a risk of irritation or allergic reaction and I consent to proceed *

Photo & Social Media Consent *

May we photograph your results and share them on our social media or website?

$25 Deposit Required *

I understand that a NON-REFUNDABLE deposit of $25 is required to secure my appointment, and will go toward the remaining balance of my service. Non-refundable $25 deposit must be made via Besmi, Square, Venmo, Apple Pay, or Zelle.

The remainder of your total balance is due in cash, card, Besmi/Square/Venmo/Zelle/Apple Pay on the day of your scheduled appointment. (Cash is preferred) *

I understand that my professional does their best to provide quality services and that my service is NON-REFUNDABLE. *

Must accept for appointment to be approved

* A Late Cancelation Fee of 100% of your scheduled service will be applied using the card on file if given less than 48 hours before your scheduled appointment. * *

* A No-Call/No-Show Fee of 100% of your service will be applied using the card on file if you miss your appointment. While I understand that things do happen, please reschedule/cancel no less than 48 hours to avoid any fees. * *

Must accept for appointment to be approved

I agree and understand that Lash Up Lace Up & my Lash Technician has no way of knowing if the client is allergic to some of the products or materials being used in any eye-lash procedure, though we do use sensitive eye products to ensure comfort every client is different. I will seek medical care (at my own expense) and contact my lash techimmediately if any allergic or adverse reaction occurs. All of my questions were answered and I understand the procedure and risks. *

Must accept for appointment to be approved

I consent to putting my debit or credit card on file in order to hold my appointment *

A debit/credit card is REQUIRED to HOLD your appointment. THIS DOES NOT SECURE YOUR APPOINTMENT UNTIL A DEPOSIT HAS BEEN MADE VIA BESMI, SQUARE, APPLE PAY, ZELLE OR VENMO. * Your card on file WILL NOT BE USED to pay for any part of your appointment and will only be charged in the event of applicable fees. * You can send your deposit via Venmo @lashuplaceup.

I release Lash Up Lace Up from any and all liability associated with this procedure. This service will be performed with the utmost attention to safety, sanitation, and proper application using tools and products that the technician has been trained and certified to use. This service has many variables due to lifestyle, moisture, weather, extreme temperatures, natural eyelash shedding and other factors. *

Must accept for appointment to be approved

Client Signature *

Sign here

By signing my signature, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.

Thanks so much for completing your Intake/Consent Form! We’re looking forward to seeing you at your visit at Lash Up Lace Up! Sending love & light 💫 LULU 🤍

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Lash Up Lace Up LLC

Lash Client Intake/Consent Form

Full Name *

Enter first and last name

Phone Number *

Enter best phone number to send confirmations, reminders and receipts to

Email *

Enter best email to send confirmations, reminders and receipts to

Date of Birth *

Enter your date of birth (i.e. 06/17/1991)

Requested Appointment Time/Date *

Enter your requested appointment time and date.

I have had eyelash extensions done before *

Select yes or no

Allergies or Sensitivities *

List any known allergies (adhesives, latex, etc.) or eye sensitivities

I understand I should not wear mascara or curl my lashes before my appointment *

Please come to your appointment with a clean face, and no makeup on your eyes

Eye Conditions *

Have you had any eye surgery, infections, or conditions in the past 6 months?

I understand there is a risk of irritation or allergic reaction and I consent to proceed *

Photo & Social Media Consent *

May we photograph your results and share them on our social media or website?

$25 Deposit Required *

The remainder of your total balance is due in cash, card, Besmi/Square/Venmo/Zelle/Apple Pay on the day of your scheduled appointment. (Cash is preferred) *

I understand that my professional does their best to provide quality services and that my service is NON-REFUNDABLE. *

Must accept for appointment to be approved

* A Late Cancelation Fee of 100% of your scheduled service will be applied using the card on file if given less than 48 hours before your scheduled appointment. * *

Must accept for appointment to be approved

I consent to putting my debit or credit card on file in order to hold my appointment *

Must accept for appointment to be approved

Client Signature *

Sign here

By signing my signature, I verify that I have read and understand the above statements and agree to have answered medical questions honestly to my knowledge.

Thanks so much for completing your Intake/Consent Form! We’re looking forward to seeing you at your visit at Lash Up Lace Up! Sending love & light 💫 LULU 🤍