NEW CLIENT INTAKE FORM

Name *
Name
Address
Address
Date
Date
DOB
DOB
How did you hear about us?
Phone *
Phone
Is this the first time you have had lash extensions applied? *
If you answered NO, Do I need to allow additional time to remove your previous set of eyelashes (It's recommended to remove)?
Contradictions: Please check all that apply: *
Please use your mouse or if you are using at touch screen device your finger to sign in the signature box below.
Signature
Thank you for taking the time to fill out the form and putting the safety of your eyes in my hands!