Eyelashes Extension Client Record Form PDF Details

If you're a cosmetologist, then you know that one of the most popular services offered is eyelash extensions. As a professional, it's important to keep track of your clients' information so you can provide the best service possible. This client record form is designed to help you do just that! It includes all the information you need to know about your clients, from their name and contact information to their medical history and preferences. Keep this form handy so you can easily track your clients' progress and make sure they have an amazing experience!

QuestionAnswer
Form NameEyelashes Extension Client Record Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameswax brow lashes client information sheet, client consultation form for eyelash ext, lash client record pdf, printable eyelash client record cards

Form Preview Example

EYELASH EXTENSIONS INTAKE FORM

Name:

 

 

 

DOB:

 

 

 

 

Age:

 

 

Gender:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

City:

 

 

State:

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone:

 

Cell:

 

 

 

 

 

Work:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address:

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Your email address will be used for appointment confirmations, quarterly newsletters, and to alert you of specials and promotions.)

How were you originally referred to Bella Via? (Please circle and add note if applicable.)

Dr. Colville Dr. Zavell Website Friend:

Other:

 

 

AREA SPECIFICS

 

 

 

 

Is this the first time that you have had eyelash extensions applied?

YES

NO

 

 

If no, where did you have them applied?

 

 

 

 

 

 

Please indicate if you have worn any of the following types of eyelashes within the last 60 days:

 

 

□ Individual

□ Strip

□ Flare

□ Other

 

 

 

 

Do you do any of the following to your eyelashes? (Please check all that apply.) □ curl

□ perm

□ tint

 

Are you having eyelash extensions applied for: □

daily wear

□ a special occasion

 

 

Do you wear contacts?

YES

NO

 

 

 

 

 

Do you habitually rub, pull, or pick your eyelashes for any reason?

YES

NO

 

 

Do you have, or are you being treated for, any eye illness or injury?

YES

NO

 

 

What side do you predominately sleep on?

 

RIGHT

LEFT

 

 

Please list any eye drops or eye medications that you are currently using:

Do you have any allergies to adhesives, tape, paper tape or synthetics?

YES

NO

If so, please list your reaction(s):

 

 

 

Are you able to keep your eyes closed and lie still for up 2 hours or longer?

YES

NO

Please check any of the following that apply to you:

□ Lasik Eye Surgery

□ Dry Eye

□ Permanent Cosmetics

□ Blepharoplasty

□ Microdermabrasion

□ Seasonal Allergies

□ Alopecia

□ Thyroid Diseases

□ Glycerin Allergies

□ Iron Deficiency

□ Ringworm

□ Major Surgery

□ Eating Disorders

□ Oral Contraceptives

□ Anticoagulants

□ Retinoids

□ Accutane

□ Beta-adrenergic Blockers

□ Chemotherapeutic Agents

□ Hormonal Imbalance

□ Recent High Fever

□ Severe Illness

□ Flu Symptoms

□ Extreme Stress

□ Drugs that Cause Hair Loss

 

□ Childbirth within the last 120 days

□Exposure to Chemicals in Swimming Pools, Bleach, Hair Dye, or Perms

□Hypersensitivity to Cyanoacrylate or Formaldehyde

How to Edit Eyelashes Extension Client Record Form Online for Free

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Step number 1 for submitting printable eyelash extension client record cards

2. After filling in the last part, go to the next part and enter the essential particulars in all these blanks - Is this the first time that you, Do you wear contacts Do you, YES NO, YES YES RIGHT, NO NO LEFT, Please list any eye drops or eye, Do you have any allergies to, YES, Are you able to keep your eyes, Dry Eye Seasonal Allergies Iron, Blepharoplasty Thyroid Diseases, and Permanent Cosmetics Alopecia.

NO NO LEFT, Are you able to keep your eyes, and YES NO of printable eyelash extension client record cards

3. The following portion is focused on Are you able to keep your eyes, Dry Eye Seasonal Allergies Iron, Blepharoplasty Thyroid Diseases, Permanent Cosmetics Alopecia, Extreme Stress, Exposure to Chemicals in Swimming, and Hypersensitivity to Cyanoacrylate - complete all these empty form fields.

Step number 3 for submitting printable eyelash extension client record cards

Be really mindful when filling out Permanent Cosmetics Alopecia and Hypersensitivity to Cyanoacrylate, as this is the part where most people make a few mistakes.

Step 3: Once you have glanced through the information in the document, press "Done" to finalize your document generation. Right after registering afree trial account at FormsPal, it will be possible to download wax brow lashes client information sheet or email it directly. The PDF document will also be easily accessible via your personal account with your changes. FormsPal is focused on the privacy of our users; we make sure all personal information coming through our system continues to be secure.

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