WELCOME TO SUBURBAN LASH & BEAUTYNEW CLIENTSPlease complete this form prior to your appointment.This form applies to new lash clients only OPEN FORM New Lash Clients Name * First Name Last Name Phone * (###) ### #### Email Address * How should we contact you? * Call Text Email Have you had this treatment done previously? * Yes No Do you habitually pull, pluck, or pick your eyelashes for any reason? * Yes No Do you have, or are you being treated for any eye illness or injury? * Yes No Are you able to keep your eyes closed and lay still for up to 3 hours or longer? * Yes No Please check any of the following that may apply to you: Lasik Eye Surgery within 6 months Permanent eye makeup Blepharoplasty (eye lift) Microdermabrasion within 2 months Allergies to synthetics such as acrylic nails Hypersensitivity to cyanoacrylate or any other adhesives Alopecia Thyroid diseases Pink eye Sty Hormonal imbalance or extreme stress Drugs that may cause temporary hair loss Chemotherapeutic agents used in cancer treatments Retinoids (Ex: Accutane or Retin A) Anticoagulants (Beta-adrenergic blockers used to control blood pressure) Anything else we should know? To ensure the highest quality of service and best results, we ask our lash clients to please respect our salon rules found below. * Please do not wear eye makeup, perfume, or any heavily scented lotions to your appointment. No caffeine 4 hours prior to the start of your appointment as you are expected to lie still for the duration of the service. Please use the restroom upon arrival and turn off your cell phone. Gum chewing is not permitted as it causes the face to move. Please arrive alone to your appointment (no children or friends). I agree I disagree Please read our terms & conditions found here * I have read and agree to the terms and conditions. We cannot offer refunds on lash services. We do offer complimentary removals of lash extensions. * I understand We respect your privacy. Thank you!