Name *
Phone *
Date of birth *
Date of birth
Preferred appointment location? *
Please select any additional services you'd like to include with a Lash Lift
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.
Today's Date *
Today's Date