LVL Consultation Card

First Name

Last Name

Date of Birth

Age

Phone

Address & Postcode

GP Name

GP Phone

Have you ever had an allergic reaction? YesNo

Have you had any surgery recently? YesNo

Do you take medication? YesNo

Do you have any broken skin? YesNo

Do you have any skin conditions pertaining to area being treated? YesNo

Are you pregnant? YesNo

Have you had LVL or lash tinting in last 3 weeks? YesNo

Do you wear contact lenses? YesNo

Please Sign Here:

Before & After Care
Before treatment: Please remove creams, oily products & eye make up. I would advise showering before you arrive. Remove contact lenses and bring your glasses for your journey home. After treatment: No eye makeup or moisture including water, steam, sweat for 24 hours after treatment. For 24 hours avoid touching or rubbing your eyes to keep lashes straight and in position, comb them when necessary. Don’t perm them or use lash curlers.

I have read, understood and agree with the before/after care instructions above:Yes

I have read, understood and agree with the COVID-19 Policy Yes

I have read, understood and agree with the Terms & Conditions Yes

I have read, understood and agree with the GDPR Privacy Policy