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Empower Beauty Lash Extension Consultation Form

Birthday
Day
Month
Year
What services have you booked in for?
Have you had lash extensions before
Yes
No
Have you had any form of eye surgery in the past 6 months?
Yes
No
Do you wear contact lenses? If so, please remove them before any lash extension service.
Yes
No
Are you currently pregnant or breast feeding?
Yes
No
I consent to having my images taken for promotional and advertising purposes
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Date
Day
Month
Year
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