Client Information Form Date Format: MM slash DD slash YYYY List any serious or chronic illness, operations, chronic virus infections, or traumatic accidents you have had:Do you give permission for photo to be taken and use for promotional purposes?Please check the treatments you have had in the past and give details if you had any reactions: Lash Lift Lash Perm Last Tint Lash Extensions Reactions Waxing DetailsDo you currently have any allergies or skin conditions including: Herpes Simplex Psoriasis Eczema Conjunctivitis Dry Eye Syndrome Eye Infection Trichotillomania Alopecia Other Are You?Pregnant Yes No Breastfeeding Yes No Are you on any medication that may affect the sensitivity of your skin: Yes No Did you have a patch test done before your treatment:(done 24hrs prior to the treatment) Yes No Do you want a patch test done prior to your treatment:If Yes, please rebook your appt after 24hrs Yes No We advise a patch test for any treatment you chose to undertake. If you choose not to have patch test we are not responsible for any reaction that on the rare event may occur. If you have any medical concerns about your suitability for any of our treatments please seek medical advice.In case of emergency notify: * I accept I will be charged a cancellation fee of 50% of any bookings I make if I cancel with less than 24 hours notice or fail to show to my appointment. I consent Light Lash Bar is not responsible for my decision in carrying out any treatments. I understand the longevity of any treatments will vary depending on the condition of the area being treated, the treatment I choose and my aftercare. Light Lash Bar is not responsible for any allergic reactions I may in the very unlikely event experience. If my medical condition changes it is my responsibility to inform Light Lash Bar prior to any future appointments.
