CLIENT

RECORD
BOOK
LYNA LASHES

NAME:
 CLIENT INTAKE FORM
NAME: PHONE:

EMAIL: DOB: INSTAGRAM:

PREFFERED EYELASH SET: CURL: LENGTH:

OCCUPATION:

MEDICATION:

ALLERGIES:

ANY RECENT EYE IRRITATION?:

WHEN IS YOUR SHEDDING SEASON?

HOW DID YOU HEAR ABOUT ME?: INSTRAGRAM WEBSITE FACEBOOK

FRIEND / REFERRAL:

HAVE YOU HAD LASHES DONE BEFORE?: YES / NO

DO YOU WEAR CONTACTS?: YES / NO

DO YOU HAVE DRY EYES?: YES / NO

DO YOU HAVE WATERY EYES?: YES / NO

ARE YOU CURRENTLY USING LASH SERUM?: YES / NO

CAN I USE YOUR PHOTOS FOR MARKETING PURPOSES?: YES / NO

 PLEASE WRITE YOUR NAME:

I AGREE TO HAVE EYELASH EXTENSIONS APPLIED

TO MY NATURAL EYELASHES, REMOVED, OR RETOUCHED BY THE

CLIENT CONSENT FORM

CERTIFIED EYELASH EXTENSION TECHNICIAN.

I UNDERSTAND THAT THIS PROCEDURE ENTAILS WITH

SYNTHETIC EYELASHES BEING APPLIED.

I UNDERSTAND THAT I HAVE TO KEEP MY EYES CLOSED

THROUGHOUT THE ENTIRE PROCEDURE (UP TO 3 HOURS).

I UNDERSTAND THAT THERE ARE POSSIBILITIES FOR

REDNESS, IRRITATION, SWELLING, ITCHINESS, AND OTHER
RISKS THAT CAN ARISE DURING AND AFTER PROCEDURE.

I UNDERSTAND THE POST CARE TREATMENT FOR MY EYELASH

EXTENSIONS.

I UNDERSTAND THAT I NEED TO PAY ADDITIONAL FEE FOR

LASH BATH/CLEANSE IF MY EYES ARE NOT CLEAN.

I UNDERSTAND THAT THIS PROCEDURE IS SEMI-PERMANENT

AND THE NATURAL LASHES WILL CONTINUE TO GROW.
REGULAR FILL APPOINTMENTS MUST BE BOOKED TO
MAINTAIN A FULLER SET.

I UNDERSTAND THIS SERVICE IS NON-REFUNDABLE.

I HAVE READ AND UNDERSTOOD THIS WAVIER FORM.

I HAVE COMPLETED THIS FORM TO THE BEST OF MY

KNOWLEDGE.

I UNDERSTAND THAT BY SIGNING THIS WAVIER, I RELEASE

MY EYELASH TECHNICIAN FROM ANY CLAIMS.

SIGNATURE: DATE:
 CLIENT RECORD
NAME: PHONE:

LIFESTYLE: DOB: REFFERED BY:

NOTES:

MEDICAL INFO
ALLERGIES:

MEDICATION:

GLASSES: NOTES:

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