moualashco

Client Intake Form

Full Name *

Email *

How did you hear about "Moua Lash Co"?

Phone Number

Non-refundable

I understand that this is a non-refundable service.

Stay Connected

Would you like to receive exclusive offers, updates, and promotions from us via email, or text? Your privacy is important to us, and we promise to keep your information secure.

Are You Pregnant or Nursing?

Social Media and Content

Does "Moua Lash Co" have permission to use photos and/or videos that include you on our social media platforms as well as social media marketing purposes? You are not required to select "Yes" to receive services or goods.

Allergies/Sensitivities? *

Consent

I understand that the adhesives and adhesive remover are a skin, eye, and mucus membrane irritant, and that in rare cases persons may be allergic to or have hypersensitivity to synthetics, cyanoacrylate, or formaldehyde which may be present in the adhesive. I understand that the procedure requires that I must lay still for up to three hours with my eyes shut. I understand that I must remove any contact lenses for the duration of the procedure. I understand this agreement will remain in effect for this procedure and all future follow-ups conducted by "Moua Lash Co". I further state that I have no known medical conditions that may be aggravated by the procedure, or any medical conditions that would prevent me from complying with the instructions of my lash artist. Prior to booking, I acknowledge that I have read all of the policies & pre-booking info (Policies & Pre-booking Info – Moua Lash Co).

Signature *

Sign here

By signing above, I certify that I fully understand and comply with the above as stated. I acknowledge that I have been advised of the potential harmful and or negative side effects, and that I have fully read and understand all of the information in this agreement.