Intake form

Help us serve you better

Name *

Email address *

Phone number

Preferred appointment date

Preferred appointment time

What services are you interested in?

Please select at least one option.

Eyelash Extensions

Brow Shaping

Brow Tinting

Eyebrow Lamination

Lash Lift

Brow Microblading

Have you had any previous eyelash or brow treatments?

If yes, please specify

Do you have any allergies or sensitivities?

How did you hear about us?

Additional questions or comments

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Eyelash and Brow Tech