Eyelash Extension Service History Form
Please complete this form to help your technician understand your lash extension history and preferences.
Client Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Appointment Date and Time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Lash Extension Status/History
*
No extensions currently
Wearing extensions
Removed extensions recently
Other
Date of Last Lash Extension Service
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Previous Lash Style/Type
Please Select
Classic
Hybrid
Volume
Mega Volume
Other
Allergies or Sensitivities Related to Lash Products
Current Concerns or Issues with Lash Extensions
Desired Outcome/Preference for Next Service
Additional Notes
Submit
Should be Empty: