NEW CLIENT REGISTRATION FORM

To offer you the best possible service and experience we ask that you take
a few short minutes to fill out our new client registration form below.


PERSONAL CONTACT INFO *
PERSONAL CONTACT INFO
Date of Birth
Date of Birth
Address *
Address
Phone *
Phone
EYELASH EXTENSION HISTORY
If you received lash extensions that you were unhappy with in the past, please describe what was wrong with them.
HEALTH HISTORY
Do you have any known allergies?
Please check any/all that apply.
Please note that many medications have a side effect of hair/natural eyelash loss. Please check the conditions that apply.
LASH EXTENSION STYLE
Lash Style Request
Please select a lash extension style you'd like us to create from the choices below.
What is your desired lash look?
Please select from the choices below.
REFFERAL
How did you hear about us? *
AUTHORIZATION
Your Signature *
Your Signature
I(hereinafter the “client”) authorize Lust for Lashes at (1241 Dundas Street West, Toronto, Ontario) a trained and certified lash extension professional, to perform the application of eyelash extensions. A thorough explanation of the procedure, processes, and any procedural complications will be discussed with me. I will also be provided with aftercare instructions and I will adhere to those instructions. This will represent your signature that you have disclosed all correct information above and agreed to the noted above terms
Date *
Date