Customer Information Form

Cozy Lash Bar
Contact
Price List
Our Policies

Cozy Lash Bar
Contact
Price List
Our Policies

Book Online

0490 844 612

Customer Information Form

Please fill the form carefully and answer all the questions.

INSTRUCTIONS: You must complete this consultation for each client that you conduct eyelash extension services for. Use this form when consulting with the client and after completion of the set/removal. You will need to make sure you take a before picture and after picture with eye pads on, clear and close up to see the work.

Full Name

Contact Number

Address

Age

Please advise what service you are having today?

What look are you hoping to achieve today?

1- Do you suffer from the following?

Abnormal or sensitive skin Allergies to latex, tape resin, and adhesive Alopecia Bacterial, fungal, parasitic, or viral Infections Blepharitis Cataracts Conjunctivitis Contact lenses Curly eyelashes Damaged natural eyelashes Dry eyes syndrome Glaucoma Other allergies Recent eye surgery Skin disease or disorder Styes Trichotillomania Twitching eyes Watery eyes Other None

2- Have you had lashes done before?

Yes (No if we need to do a patch test) No

3- Have you had a previous reaction to lashes in the past?

Yes No (Pls explain in the field below)

3.1 - Explanation for Question 3 (If Answered Yes)

4- Do you use eye drops?

Yes No

5- Do you use regular sunscreen?

Yes No

6- Do you participate in sport or exercise?

Yes No

IMPORTANT NOTES:

Please read below important notes:

- If you wear Contact Lenses it is suggested you remove them when completing the lash service.
- It is your obligation to inform us about any health issues and read and answer this form carefully to prevent any future problems and / or side effects from used material or products.

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Customer Information Form
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Price List
Our Policies
Customer Information Form
Confirmation

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0490 844 612

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Customer Information Form

Please fill the form carefully and answer all the questions.

IMPORTANT NOTES:

Please read below important notes:

- If you wear Contact Lenses it is suggested you remove them when completing the lash service. - It is your obligation to inform us about any health issues and read and answer this form carefully to prevent any future problems and / or side effects from used material or products.

- If you wear Contact Lenses it is suggested you remove them when completing the lash service.
- It is your obligation to inform us about any health issues and read and answer this form carefully to prevent any future problems and / or side effects from used material or products.