Lash Nap Client Intake Form

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Help us get to know you better so we can service you best! Feel free to ask us any questions you may have after completing this form.

First Name *

Last Name *

Email *

Billing Address and Zip Code *

Phone number *

Date of Birth *

YYYY

Do you consent to disclosing any health, injury, medications, surgeries, pregnancy, allergies, and or any information that may affect your treatment today?

I am currently taking prescription medication

I am pregnant or nursing

I have allergies and sensitivities to adhesives like band aids or patches

I don't have any information to disclose that will affect my treatment

How did you hear about Lash Nap? *

By checking this box, you are agreeing to receive a treatment that may cause red, puffy, dry or watery eyes. * *

Patch tests and lash adhesive for sensitive eyes are available upon request.

Required

By checking this box, you agree that your Lash Artist cannot guarantee the outcome of your eyelash extensions if your lashes are not completely make up free, oil free, or completely clean. For Lash Lifts, you are agreeing that your last lash lift is at least 8 weeks from your last service. For Henna Brows, you are agreeing that you are not adversely affected by henna products or formulas. *

I am getting LASH EXTENSIONS, I am agreeing to the above statement

I am getting a LASH LIFT, I am agreeing that I have not received a lash lift treatment in the past 6 weeks. I also agree that I cannot receive another lash lift service until 6 weeks after today's appointment.

I am getting a BROW LAMINATION and/or HENNA BROW, I am agreeing to the above statement

Required

By checking this box, you are agreeing to our 24 hour cancellation policy. No shows or late cancellations are subject to half the cost of the scheduled treatment. Arrivals 15 minutes past the scheduled time will be rescheduled. * *

No shows or late cancellations with discounts, deals, promotions (like: Groupon, Living Social, Yelp), gift certificates, or prepaid treatments, will be subject to coupon redemption and/or forfeit the special deal or offer.

Required

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