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Client Health History: Lash Extensions

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