Eyelash Serum Safety Questionnaire Form
Complete this form to help determine your readiness and eligibility for safe eyelash serum use.
Are you interested in using an eyelash serum for personal use?
*
Yes
No
Do you have a history of eye or skin sensitivity?
*
Yes
No
Not sure
Are you currently experiencing any eye irritation, infection, or other eye conditions?
*
Yes
No
Do you wear contact lenses?
*
Yes
No
Occasionally
Have you ever had an allergic reaction to cosmetics or eye products?
*
Yes
No
Not sure
Are you currently pregnant or nursing?
*
Yes
No
Not applicable
Are you taking any medications or undergoing treatments that affect the eye area?
*
Yes
No
Not sure
Have you used an eyelash serum before?
*
Yes, with no issues
Yes, with some irritation
No
If you answered 'Yes' to any of the above, please provide brief details (optional):
I acknowledge that I will follow all product directions and discontinue use if any irritation or discomfort occurs.
*
I acknowledge
Submit
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