Lash Extension Client Intake · Revival Beauty Co.

Full Name *

Phone Number *

Date of Birth

How Did You Hear About Us?

Have you had lash extensions before? *

Desired Lash Style *

Allergies or Sensitivities *

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

Eye Conditions

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

I understand I should arrive with clean, makeup free lashes *

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?

Inspiration Photos

Please upload any inspiration photos you have here

Client Signature *

Sign here

By signing, you acknowledge and agree to the above