Welcome. Lash Lift Form Name * First Name Last Name Date Of Birth * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Would you like to learn more about skincare and lash/brow products? Sure! No, thank you. Would you be okay with Paige taking before & after photos, that she could share for marketing purposes? OMG, of course! No, thank you! PREVIOUS DISCOMFORT, STINGING OR ADVERSE REACTIONS: Please click any that apply: Skin Disorders Eye infections Watery eyes Bell’s Palsy Allergies to Latex/band aids Are you pregnant/lactating? Recent eye surgery Hay Fever Previous reactions to eye treatments Allergies to glue/bonding agents/adhesives Are you on the contraceptive pill? Eye Disease Blephartitis Allergies Contact Lenses Allergies to acetone Are you taking HRT? Any medications * Other relevant information * Have you had Lash or brow tinting, lash lifting, lash perming, eyelash extension or semi-permanent mascara applied previously? * Yes No Sign and Read Consent: * I request and consent to these procedures being carried out today without undergoing a sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the products. I understand the contents of this form and take full responsibility for my actions, thus absolving all other parties of their responsibilities, if any, associated with the supply of the products and services(s). 🩷 You are beautiful! Thank you! 🩷 320 Kokanee LoopCle Elum, WA 98922 Follow forSpeical Offers!
