Revival Beauty Co.

Korean Lash Lift Client Intake

Full Name *

Phone Number *

Date of Birth

Have you had a lash lift before? *

If yes, when was your last one?

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?

Are you using any topical Retinol or Tretinoin? *

YesNo

I understand to stop topical Retinol or Tretinoin for at least a week before receiving this service *

This is to ensure no reactions occur during the service as retinoids thin the skin and can cause irritation. You may resume usage the day following your lift.

How Do You Sleep At Night? *

SideStomachBack

click all that apply

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

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?

Client Signature *

Sign here

By signing, you acknowledge and agree to the above

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