Client Information
Name
*
First Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency Contact Details
**under age of 18
If you are a minor, in case of emergency, we will contact the person below:
Emergency Contact Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Relationship
Signature of parent or guardian if under the age of 18
Please sign here
Previous lash experience
Have you ever had previous irritations to lash extensions?
*
If yes, please specify on the field above.
Do you have any allergies to Latex?
*
If yes, please specify on the field above.
Do you usually rub, pull, or pick your lashes?
*
If yes, please specify on the field above.
Reason for switching Lash artists?
If yes, please specify on the field above.
Any concerns you have regarding Lash extensions I should be aware of?
*
If yes, please specify on the field above.
Consent and Waiver
LashedX Consent Form
*
I certify that I have read this entire informed consent & I understand and agree to the information provided in the form. My questions regarding lashes have been answered satisfactorily. I hereby release anyone working at LashedX from all liabilities associated with services received there.
I give permission to LashedX to use any photos taken for instagram and/or promotional events.
I acknowledge that all information I provided in this form is true and accurate.
I acknowledge that I am coming to this appointment at my own risk. LashedX is taking all necessary precautions regarding COVID-19 sanitary stipulations and will not be held liable for any COVID-19 related illness's .
Signature of the Client
Please sign here
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: