New Client Appointment Request for LASH LAb eyelash extensions

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* Indicates required field

CONTACT

Name *

First

Last

Email *

Mobile Number *

Instagram *

How did you hear about us? *

Other or Referrals Name *

Availability

Weekdays *

Mornings Afternoons Evenings Available Anytime Not Available

Weekends *

Mornings Afternoons Evenings Available Anytime Not Available

General availability notes / special event date? *

WAX SERVICE REQUESTED

Please indicate service so we can call you *

LASH SERVICE REQUESTED

Do you have extensions on now? *

What Level Fullness / Service do you want to book? *

Add on Service *

Dry Eyes? Therapeutic Eye Spa Massage Patch Test - $25 Removal

Any conditions or active health related issues that could be area for concern? *

Please tell us if you have any active infections, allergies, eye conditions, auto-immune disease, hormone related therapy or medications that may cause you to have a hyper sensitivity to this service. If you have undergone recent surgery or chemo, please let us know.

SPECIALS

Do you qualify for any of the following? *

Offers cannot be combined and must be added at the time of booking

If you have a discount, please provide info here prior to confirmation *

Not all offers are applicable for all artists.

PAST EXPERIENCE

Any of these situations? *

Red eyes Puffy Lids Scratchy/Dry eyes Morning Goup Itchy lashline Poking Burning during appointment Burning after appointment Lashes don't stay on None of the above

Experience Notes *

LASH DESIGN OPTIONS

How involved in design do you care to be? *

Do you want to schedule a FREE video consultation? *

Yes

Fullness *

Shape *

Length *

Darkness *

Curl *

Describe your eyes/lashes: *

Describe your eyeshape or notes about your lashes or anything you want us to know re: your preferences

Select to indicate acknowledgement of all: *

24 hour cancellation policy Fill = no more than 1/2 gone No cash refunds on labor Design changes available on first fill Original artist subject to availability Artist may take before & after's Gratuity appreciated in cash I do not agree to 1 or more of the above

Lash Academy - Call me if you need volunteer model *

yes no

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