Rosa Menendez

Lash Client Intake

Your Information

First Name *

Last Name

Phone

Full Name *

Phone Number *

Date of Birth *

I have 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 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