Lash Extension consult form
Sign in to Google to save your progress. Learn more
Full name  *
Todays date
MM
/
DD
/
YYYY
Phone number *
Email address  *
Would you like to be added to our email list for special offers?
Clear selection
How did you hear about Meg Wheeler Esthetics?
Have you had lash extensions before? *
Have you had a lash lift before? *
Do you wear glasses and or contacts  *
Do you have frequent eye irritation, watery or dry eyes? *
Do you have an allergies? *
If yes to allergies, what are they?
Please check any of the following that apply to you?
Goals for your lashes?
I hereby consent to and authorize Meg Wheeler at Meg Wheeler Esthetics to apply semi-permanent eyelash extensions. In order to minimize the risk of injury I understand that it is my responsibility to lay completely still during the application of lash extensions unless directed otherwise. All risks and potential complications including but not limited too, redness, irritation, an allergic reaction to the lashes, glue or tape have been fully disclosed to me. I certify that I understand these risks and potential complications, and that I knowingly and voluntarily consent to the application of semi-permanent eyelash extensions. 

If at any time I feel uncomfortable during the appointment, I agree to immediately notify Meg. Meg will seek out immediate remedy of the problem, including ended the service if needed. I acknowledge that the longevity of the lash extensions have been made and that its highly recommended to come back between 2-3 weeks for a fill.  I herby certify that I have disclosed all conditions regarding my health, medications, and past reactions, treatments, and medications. 
MM
/
DD
/
YYYY
Time
:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy