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.
LASH EXTENSION STYLE
Lash Style Request
Please select a lash extension style you'd like us to create from the choices below.
REFFERAL
How did you hear about us? *
AUTHORIZATION
Waiver
i understand that this procedure requires single synthetic eyelashes to be adhered to my own natural eyelashes. I understand that what i want may not be identical to pictures i have seen, as the amount of lashes i have will be the guide to what length, curl and thickness i can receive. i understand that it is my responsibility to keep my eyes closed and be still during the entire procedure, since tweezers and glue are by our eyes. i understand that some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if i open my eyes. i agree to disclose any allergies i have to surgical tapes, cyanoacrylate, creams etc. i agree that by reading and signing this consent form, i release Lust For Lashes from any claims or damages of any nature. i understand that an allergic reaction is possible from the adhesive causing redness along the eyeline and swollen eyes. An allergic reaction could happen immediately, a few months, or years later or not at all, however; i am fully aware that this is a possibility. I understand that i requested for the service and a trained professional will perform the service to it’s highest standard. If a reaction does occur, i agree to contact Lust For Lashes to have them removed at no charge and i also understand that a refund will not be provided.
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