Waxing 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-W 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 Milk, Acrylic or Latex? *MilkAcrylicLatexOtherIf 'Other', please detail:Have you received Body Waxing before?YesNoDid you experience any issues with your previous body waxing?YesNoIf 'Yes', please detail:CLIENT NAME (PRINTED): *Date * Send Form To Loan Lash Spa