Home
About Us
Our Prices List
Membership
Deals
Forms
Food Menu
Blogs

021 010 0229
Contact Us

Eyelash Extensions Client Indemnity Form

Home
Eyelash Extensions Client Indemnity Form

Client Information

Name & Surname

Appointment Date

Physical Address

Email

Phone

Who Referred you?

Please Check The Relevant Boxes:

Please Check The Relevant Boxes:

Recent eye surgery Pregnant or breastfeeding Recent eye irritation or injury Dry eyes Seasonal allergies Eye infection Permanent eyeliner Previous allergic reactions to eyelash extension adhesive Very oily hair/skin Allergies to adhesives found in band-aids or medical tape Allergies to cyanoacrylate adhesives(i.c. surgical glue) Allergic to latex or acylic Recent illness or operations? Any medical conditions that may cause hair and eyelash loss: hyperthyroidism, alopecia areata Trichotillomania ( hair pulling disorder) Chemotherapy treatments in the last 6 months Contact Lenses Frequent eye irritation, itching or watering eyes Blepharoplasty Blepharitis (inflammation of cyclids) Hormonal imbalance

Other Medical Information

Our Beauty Bar Aims to deliver the best all over grooming experience and high notch service excellence

Coco Vogue © All Rights Reserved - 2025 - Voomay Designs

0

0

Your Cart

Your cart is emptyReturn to Shop

To find out your shipping cost , Please proceed to checkout.

Continue Shopping

WhatsApp us

Enjoy a 10% discount on your First purchase!

Use:10Coco

Available to the first 20 people.