eyelash extensions suitability form

Name:
Email:
Contact number:
How did you hear about us?
Appointment day and time: (Please indicate preferred day/time if you haven't had one fixed yet)
Choose your preferred location:	Colindale, NW9 5DE (Evenings & Weekends) Feltham, TW13 4GR Mobile London within M25
If you have opted for our mobile service please enter your full address:

Have you had lash extensions before?	Yes	No
What colour are your lashes?	Dark	Fair

Medical questions:
Have you had in the past 4 weeks: pink eyes, sty, allergies or any infections etc?	Yes	No
Do you have Alopecia, cancer, Thyroid medication, post-partum, Eczema, etc...?	Yes	No
Are you prone to itchy eyes or irritation around your eyes from makeup, hay fever or habit?	Yes	No
Have you recently had eye laser surgery in the last 4 months?	Yes	No
Have you recently had your lashes dyed in the last two days?	Yes	No
Have you had your lashes permed in the last three months?	Yes	No