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Eyelash Extension Appointment -Form Fill
Q1
First Name
Name
Q2
Last Name
Name
Q3
Phone Number
Q4
Email
Q5
Health History | Please check any of the following:
Allergic to glycerin, latex, cyanoacrylate, or acrylic
Allergic to nail glue
Allergic to adhesive band-aid or medical tape
Have an eye illness-injury
Have inflamed eyelids
Have permanent eye make-up
Eye-lift
Other
Q6
Have you had eyelash extension before?
Yes
No
Q7
Date
Q8
Signature
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