Eyelash Extension Maintenance Checklist Form
Track and record eyelash extension aftercare and maintenance for optimal results. Please complete all relevant sections to ensure comprehensive care.
Client Name
*
First Name
Last Name
Date of Maintenance Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you avoided water, steam, and oil-based products around your eyes in the last 24 hours?
*
Yes
No
Which aftercare steps have you consistently followed?
Brushed lashes daily
Used recommended cleanser
Avoided rubbing eyes
Slept on back
Other
Are there any signs of irritation or allergic reaction?
No
Mild redness
Swelling
Itching
Lash Retention Observed
Please Select
Excellent (80%+ retained)
Good (60-80% retained)
Fair (40-60% retained)
Poor (less than 40% retained)
Any issues or concerns noted during maintenance?
Recommended Next Maintenance Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes
Submit Maintenance Record
Should be Empty: