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Client Health History: Lash Extensions

How should we contact you?
When is the best time to contact you?
Are you allergic to Acrylate/Cyanocarylate (bonding agent)?
Have you ever had a reaction to adhesive tape, topical creams, nail adhesives, or other topical products?
Do you have any eye disease, condition or injury that has affected your hair/lash growth or loss?
Have you ever had any of these conditions? Please select from the following:
These questions are relevant to your hair growth, and overall hair health. Please answer as fully as possible.
Are you pregnant or nursing?
Do you wear contacts?
Do you wear glasses?
Have you ever had lash extensions?
Have you ever had lash extensions removed?
Have you ever used long lasting or waterproof cosmetics?
Do you use Retin-A or Accutane?
Do you go tanning (in salon, outdoor, or spray tan)?
Have you had facial treatments?
Have you ever had Botox®, Juvederm®, or any other injectables?
Have you ever used Latisse® or any other lash growing product?
Which side do you most often sleep on?
How fast do you feel your hair grows?
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