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Lash Lift Client Intake

Your Information

First Name *

Last Name

Phone

Date of Birth *

I have had lash lift(s) done before

Are you currently pregnant or Breastfeeding? *

Hormonal changes can affect processing and results for clients who are pregnant/breastfeeding.

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 currently taking any medications that can affect your skin, eyes, or lashes? *

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 *

I understand I must keep lashes dry for the first 48 hours. *

This includes avoiding steam, hot baths/showers, saunas, excessive sweating, and swimming.

I understand I should avoid oil-based products around my eyes. *

I understand results vary based on my natural lashes and aftercare. *

I understand no guarantees can be made regarding longevity of my lashes. *

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