Eyelash Extension Consultation Form Loan Lash Spa currently has the following Lash services, Waxing & Full Facial. Loan Lash Spa services by Ms. Loan ! Classic LashesHybrid LashesVolume LashesMega Volume LashesWaxing Eyelash Lift and TintEyelash Extension RefillCluster LashesEyelash Extensions RemovalFacials Consultation Form-E Name *Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *Phone *Emergency Contact Name & Phone Number:How did you hear about us?Medical HistoryAlopeciaAutoimmune disorderBlisters/code soresBleeding disordersCancerDiabetesHeart conditionHepatitis(A,B,C,D)HIV positiveSkin ConditionsOtherIf"Other", please detail:Are you allergic to acrylic or latex? (Medical tap and adhesives required for eyelash extensions to be applied) *AcrylicLatexOtherIf 'Other', please detail:Have you received eyelash extensions before?YesNoDid you experience any issues with your previous eyelash extensions?YesNoIf 'Yes', please detail:CLIENT NAME (PRINTED): *Date * Send Form To Loan Lash Spa