New Client Consultation Form

Use this form only if you have already booked your appointment via email/text/etc. 

If you have not yet booked an appointment – please continue to the online booking page.  Your intake forms will be included as part of the booking process there. 

To expedite your appointment, please fill in the form below.  This information will be used during your initial consultation to assess suitability for eyelash extensions as well as the best approach for caring for your extensions at home.

All information submitted on this form will remain strictly confidential.






    Check all that apply to you: (required)
    I currently have a lash perm or tintI wear strips of lashes on a regular basisI use an eyelash curlerI use any of the following: mascara, eye makeup remover, eye contour cream/gelI wear contact lensesI tend to rub, pull, or pick my eyelashesI am being treated for an eye illness or injuryOily skin/hairMicrodermabrasion treatmentsMedication that affects hormones or causes hair lossNutritional concerns that cause hair lossAllergies to synthetic materials such as Latex, PBT or polyesterAllergies to adhesives (cyanoacrylates, Super Glue)SmokerPregnantDry eyesSeasonal allergiesClaustrophobic or cannot lie still for up to two hoursNone of the above apply to me


    Click to accept the terms of service below: (required)

    The information that I have provided is true to the best of my knowledge.

    I will allow photos to be taken before and after the eyelash extension application for my file and for business purposes such as marketing and promotion.

    I give permission to my therapist to perform the procedure and understand that every precaution will be taken to minimize or eliminate any negative reactions that while extremely rare, may occur. I agree to follow the aftercare advice given and understand that failure to do so can cause premature loss of the lashes for which my therapist will not be held responsible.

    If, for any reason, I have concerns or I am unhappy with my eyelash extensions then I must inform my therapist no later than 5 days after the treatment. I understand that my therapist will not issue refunds on any lash treatment, but will always work with me in the rare event of any problems. This agreement will remain in effect for the procedure and all future lash treatments and I must inform my therapist if my medical history changes.

    CANCELLATION POLICY:

    Cancellations within 24 hours, or no shows will be charged at half price. This is to cover the loss of earnings from that appointment that cannot be filled at such short notice. Please arrive on time for your designated time slot.