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Home
About Us
Services
Eyelash Extensions
Waxing
Other Services
Gallery
Promotion
Policy
Forms & Waivers
PMU Waiver
Eyeslash Waiver Form
Contact Us
Eyeslash Waiver Form
Unik Lash and Brow
JC Salon, 2650 Pearland Parkway, Suite 25, Pearland, TX 77581
Eyeslash Waiver
Client Name
(input name and business)
Date
Time
Name
DOB
Email (Disregard if booked online):
Phone No: (Disregard if booked online):
How did you hear about us (Check)?
Social Media (Google/Facebook/Yelp/ Instagram)
Web Browsing
Walk - in
Referral
Promotional Ads
Other
TELL US MORE ABOUT YOURSELF:
1. Have you had eyelash extensions put on before?
Yes
No
If "Yes" to # 1 above
If "Yes" to # I above, were undereye gel pads used?
Yes
No
If "Yes" to # I above, are you allergic to acrylate/cyanoacrylate (eyelash extension glue)?
Yes
No
If "Yes" to # 1 above, did you have lash extension removal done recently
Yes
No
2. Are you allergic to paper tape or bandages?
Yes
No
3. Do you have any allergies that affect your eyes or skin?
Yes
No
4. Do you use any topical cream or retin - A?
Yes
No
5. Have you had any recent eye surgery, eye infection or wound?
Yes
No
6. Do you have a tendency to rub your eyes or pull on your eyelashes?
Yes
No
7. Do you have back pain?
Yes
No
Signature
Submit
