Transcription of EYELASH EXTENSION INTAKE & CONSENT FORM
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EYELASH EXTENSION INTAKE & CONSENT FORM
Page 1 of 2 EYELASH EXTENSION INTAKE & CONSENT FORMCLIENT INFORMATION:Name: _____ Address: _____City: _____State: _____ Zip: _____Phone: _____Email: _____ Appointment Date & Time: D: _____/ _____/ _____ T: _____Your Certified Lavish Lashes Specialist is:_____Locataion of Service: _____Preferred Appointment Day: _____ Preferred Time: _____Customer Remarks: _____How did you hear about us? ! Lavish Lashes Web Site ! Magazine ! Google/web search ! Friend ! Other: _____Is this the !rst time you have had lash extensions applied? ! Yes ! No If no, where have you had them applied?
Page 2 of 2 CONSENT FOR EYELASH PROCEDURE: I have agreed to have Lavish Lashes™ eyelash extensions applied to and/or removed from my eyelashes.
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