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CONSULTATION FORM - Eyelash Lamination

Birthday
Day
Month
Year

Please answer the following questions honestly. This information is kept strictly confidential and used solely for your safety and wellbeing.

Do you have any known allergies (adhesives, latex, fragrances, cosmetics)?
Yes
No
Have you previously had a reaction to eyelash tinting, perming, or lamination?
Yes
No
Do you have or have you had any eye conditions (conjunctivitis, blepharitis, dry eye syndrome, styes)?
Yes
No
Have you had any recent eye surgery (including LASIK) within the last 6 months?
Yes
No
Do you wear contact lenses?
Yes
No
Are you currently pregnant or breastfeeding?
Yes
No
Do you have any skin conditions around the eye area (eczema, psoriasis, rosacea)?
Yes
No
Are you currently taking any medication that may cause eye sensitivity (antihistamines, retinoids, chemotherapy)?
Yes
No
Have you had any recent facial or eye treatments in the last 48 hours?
Yes
No
Do you have particularly sensitive eyes or skin?
Yes
No

PATCH TEST DECLARATION

A patch test is strongly recommended at least 24–48 hours prior to treatment, particularly for first-time clients or those with known sensitivities. This is in line with industry best practice guidelines in the UK.

A patch test was carried out at least 24 hours before this treatment
Yes
No
No adverse reaction to the patch test.
Yes
No

I confirm that to the best of my knowledge all information provided on this form is accurate and complete. I understand that it is my responsibility to inform my therapist of any changes to my health or medical circumstances before future treatments.


I consent to the eyelash lamination treatment being carried out today and acknowledge that I have been given the opportunity to ask questions. I accept there is a small risk of adverse reaction even with a negative patch test, and I agree to follow the aftercare advice provided.

I understand this treatment is not recommended if I am pregnant, have active eye infections, or have had recent eye surgery, and I confirm none of these apply to me (or have disclosed them above).

I confirm I am 18 years of age or over (or that this form has been completed and signed by my parent/guardian if I am under 18).

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