Name *
Name
Phone *
Phone
Date of birth *
Date of birth
Preferred appointment location? *
I have read and understand the 24 hr aftercare instructions *
-No water/steam/sweat/makeup on lashes 24 hours after as this can weaken the lift -For first night do not sleep with lashes pressed into the pillow as the shape can be affected
Please check all that apply *
Have you had any of the following services? *
Please check all that apply
Patch Test *
A patch test is recommended but not mandatory. A patch test must be performed at least 3 days before your appointment to rule out any reactions.
I have completed this form to the best of my ability. I will consult with Chelsey Cueva regarding any medicine I am currently taking and any skin tendencies that may be problematic. I give permission to Chelsey Cueva to perform the lash procedure and will hold her from any liability that may result from this treatment. I have given an accurate account of the questions asked above including all known allergies or prescription drugs or products I am currently using. I understand Chelsey Cueva will take every precaution to minimize or eliminate negative reactions as much as possible. In the event that I may have additional questions or concerns regarding my treatment or suggested home product / post-treatment care, I will consult with the Chelsey Cueva immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the liability waiver and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.
Date *
Date