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Lash Extension Consent
Please complete before your lash appointment.
Full name
*
(required)
Email address
*
(required)
Phone number
Date of birth
*
(required)
Which service?
*
(required)
Select…
Classic set
Hybrid set
Volume set
Infill
Lash lift
Removal
Your eyes
Have you ever reacted to lash adhesive or glue?
*
(required)
Select…
No
Yes
Not sure
What happened, and when?
Do any of these apply?
*
(required)
Hay fever or seasonal allergies
Dry eye
Blepharitis
Conjunctivitis now or recently
Recent eye surgery
Contact lenses
Alopecia or lash loss
None of these
Patch test
*
(required)
Select…
I've had one with you
I haven't - I understand one may be needed
Any medication or eye drops?
Are you pregnant or breastfeeding?
Select…
No
Yes
Prefer not to say
Confirmations
I understand irritation, redness and allergic reaction are possible, and that reactions can occur even after previous treatments
*
(required)
I will avoid water, steam and oil-based products for 24 hours and follow the aftercare given
*
(required)
I will not attempt to remove the extensions myself
*
(required)
The information above is accurate
*
(required)
Leave this field empty
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