LASH INTAKE FORM

Unfortunately, I do not work over other lash technician's lash. If you are a new client, your old lashes will be removed, and you will receive a new set of lash extensions.

First name

Last name

Email

Phone

Have you gotten lash extensions before?

Yes

No

Do you wear contacts? If you answered yes, please remove them before appointment.

Yes

No

Are you sensitive to Tape?

Yes

No

Have you gotten a full set by me previously? If not please book a full set unfortunately I don’t work over other lash tech.

Yes

No

COVID-19 Pre-Screening

Are you currently waiting on the results of a COVID-19 test?

Yes

No

Have you experienced any of the following symptoms in the past 48 hours:

Have you had any signs of a fever in the past 24 hours or had a temperature that has elevated 100.0F or greater?

Yes

No

Within the past 14 days, have you been in close physical contact with anyone who test positive with cov-19?

Yes

No

Identification

This is required, this is for your protection and mine.

ID