CLIENT CONSULTATION FORM 

NAME:_______________________________________________________________

EMAIL ADDRESS:__________________________________________________________

CELL PHONE NUMBER:________________________________________________

HOW DID YOU HEAR ABOUT US:________________________________________

REFERRAL NAME: ____________________________________________________

Proper home care is crucial for maintenance of your Luxy Beauty enhancements.  For best results you must follow all recommendations given to you on your take home aftercare sheet.

I grant Luxy Beauty Courses permission to use any photos or images taken for advertising purposes. 

Clients who are hyper sensitive or have concerns with allergies MUST have a patch test done at least 24 hours prior to the procedure. 

It has been recommended to perform a patch test prior to any Eyelash Extension procedure; however, I do not want a patch test against recommendation of the technician and I am waiving the patch test. 

(signature)____________________________________________________

Most spas and technicians are applying damaging sets of eyelash extensions on their clients.  After a number of fills, clients are left with very little or no natural eyelashes left at all.  This is a very serious problem that is ruining the reputation of the industry.  At Luxy Beauty you can relax during your service as your lash line health is GUARANTEED!

We employ only the most qualified and experienced lash stylists to administer your eyelash extensions.  Our highly trained technicians work each individual lash line uniquely and no two sets of lashes are ever the same!

I would like to participate in the DAMAGE FREE GUARANTEE _____________________Date:___________ 

I decline participation in the DAMAGE FREE GUARANTEE ________________________Date:____________

*For Viewing Purposes Only*

CONTRAINDICATIONS & CAUTION

Please circle all that apply :

Positive Reaction to Patch Allergy Test
Cysts
Cuts, Abrasions or Swelling Near Procedure Site
Recent Lash Service
Recent Operations Near Procedure Site
Skin Traumas
Keratitis
Contact Lenses (Remove prior to service)
Weak Eyelashes (Recommended growth serum, review in 2 months)
Sties
Blepharitis
Chemotherapy or Post Chemotherapy
Eye Infection
Skin Disease
Glaucoma
Alopecia
Habits of Rubbing or Picking Your Lashes

I’ve received a thorough consultation and pledge to follow the maintenance recommendations made by my technician. I take full responsibility for the maintenance of my Luxy Beauty Lash/Brow enhancements. The technician has discussed the realistic results that I will be able to achieve from this service

*For Viewing Purposes Only*