Eyelash History Form

Have you had eyelash extension before?
Have you used under eye gel patches before?
Have you had permanent cosmetics applied to your eyes?
Do you wear....?
Are you pregnant?
Do you have any allergy to Acrylates or Cyanoacrylates? (Found in Krazy/Super Glue. Example: Dermabond), Nail Adhesives, Tape (bandages)/Latex, or ANY allergies not included?
Have you had any eye or face treatments, surgeries, or injuries in the last 4 weeks?

Although these are not medical conditions, birth control, some acne treatments, and hormone therapy may result in the thinning or loss of natural lashes. Please list any information you’d like to give your lash artist that may have any effects on your eyelash extensions.

Please note that some medications and/or herbal supplements/vitamins may cause hair/natural eyelash loss. If you are on medications, please keep this in mind.

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4351 MAIN Street, STE. 105 HARRISBURG, NC. 28075

we are located inside Natural bliss body studio, come on in! 

hours of operation 

   Sun/Mon/Tue               Wednesday - Friday                 Saturday               

                 Closed                                    11a-6 :00P                                9A-3P                       

3442 E. Broad Street Unit D Statesville, NC. 28625

we are located inside Beyond Beauty Studio, come on in! 

hours of operation 






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