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The artists.
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Lashes + Brows
Body Sugaring + Waxing
Hands + Feet
Facials | Cosmetic Treatments | Body Contouring
Back
LASHES + BROWS
BODY SUGARING + SKIN CARE
HANDS + FEET + GEL NAILS
Body Contouring Intake + Registration
Back
THE BABE CAVE
THE LASH ROOM
Because COVID-19
Privacy
Back
Classic Lash Extensions
Lash Lift Workshop
Home
What's poppin'.
The artists.
The artists.
The services.
Lashes + Brows
Body Sugaring + Waxing
Hands + Feet
Facials | Cosmetic Treatments | Body Contouring
Client registration.
LASHES + BROWS
BODY SUGARING + SKIN CARE
HANDS + FEET + GEL NAILS
Body Contouring Intake + Registration
The policies.
THE BABE CAVE
THE LASH ROOM
Because COVID-19
Privacy
Workshops.
Classic Lash Extensions
Lash Lift Workshop
Contact us.
Subscribe.
Book now
NEW CLIENT REGISTRATION FORM : LASHES + BROWS
PERSONAL CONTACT INFO
*
First Name
Last Name
Date of Birth
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Would you like to be added to our Email list re: offers, promos, events, newsletters?
*
No
Yes
EYELASH HISTORY
Have you received lash extensions before?
*
Yes
No
Have you ever received lash extensions that you weren't happy with?
*
No
Yes
N/A
If so, please describe what you were unhappy with:
*
Lashes didn't last long
Sticking/clumping lashes
Didn't like the style
Other
N/A - I was happy with my previous lash experience
Have you ever had a lash extension removal?
*
No
Yes
Have you ever had a lash lift?
*
No
Yes
Have you ever had a lash tint?
*
No
Yes
Do you habitually rub or pull your lashes?
*
No
Yes
Do you wear contact lenses?
*
No
Yes
Do you wear eye glasses?
*
No
Yes
Have you recently had eye surgery, permanent cosmetics procedures, eye wounds or infection?
*
Within the last 6 months.
No
Yes
Do you tan (spray tan or tanning bed)?
*
No
Yes
Do you sleep on your side, back or belly?
*
Left Side
Right Side
Back
Belly
Are you using, or recently used Retin-A, Accutane or similar products?
*
Within the last 6 months
No
Yes
Do you have a history or eye disease, conditions, injury, surgery or medications that affected you hair growth?
*
No
Yes
If so, please provide details:
EYEBROW HISTORY
Have you had any of the following brow services?
*
Wax/Sugar
Thread
Tweeze
Tint
Henna
Brow lift/glaze/lamination
None of the above
Have you ever received a brow service you were not happy with?
*
No
Yes
If so, please provide details:
MEDICAL HISTORY
Are you pregnant or breastfeeding?
*
No
Yes
Do you have any known allergies or sensitivities?
*
Please check all that apply.
Latex
Acrylates/Cyanoacrylates
Tape (medical tape/adhesive bandages)
Nail adhesives
Topical creams
Under eye gel patches
Seasonal hay fever
Itchy/watery eyes
I do not have any known allergies or sensitivities
Do you have any other conditions or medications we should know about?
*
Such as thyroid, alopecia, trichotillomania, etc.
Are you able to lay on your back for up to 3 hours?
*
No
Yes
LASH + BROW STYLING and OTHER INFORMATION
What facial + cosmetic products are you currently using?
*
Eye makeup remover | Cleanser | Toner | Serums | Moisturizer | Mascara | Eye liner | etc.
Lash Goals
If having lash services, please choose the lash/lash extension style you'd like to achieve from the options below.
Natural: Subtle, natural, even mascara'd look.
Open: Longer and more volume in the middle.
Cat: Length and volume towards the outer corners.
Doll: Length and volume throughout.
Brow Goals
If having brow services done, please choose what you hope to achieve with your brows from the options below.
Natural: just a clean up
Fuller
Darker
Arched
REFERRAL
How did you hear about us?
*
Instagram
Facebook
Google
Online ad
Referral
Other
Referral?
Which one of our beautiful guests sent you our way?
CONSENT
*If you are under the age of 16, please have your parent/guardian complete this section (Waiver, Permission to use pictures, Your Signature)*
Waiver
*
I understand there are risks associated with lash and/or brow services (lash extension application, lash extension removal, lash lift/tint, brow lift/tint, henna brow, brow wax/sugar), which include, without limitation - eye irritation, eye pain, discomfort, and redness. I agree to disclose any allergies or sensitivities I may have to surgical tapes, cyanoacrylate, creams, etc. I understand that an allergic reaction is possible from lash adhesive or remover, causing redness, itching and swelling on and around the eye. An allergic reaction may happen immediately, in months or years of having lash services, or not at all. I agree to follow the care and maintenance instructions provided by my lash/brow technician. I understand that if I do not follow any or all of the care instructions, it may result in damage to my lashes/brows. I understand that any follow up care due to my own mistake or negligence, or failure to follow care instructions will be at my own expense and risk. I understand that the application of lash extensions is not a permanent procedure, as my natural lashes will continue to grow and shed, making fill appointments necessary to maintain the original look achieved every 2-3 weeks. I understand that what I want may not be identical to pictures I may have seen, as the amount, length and thickness of my natural lashes will determine the length, curl and thickness I can receive. I agree, during a lash procedure, to keep my eyes closed and remain still during the entire procedure, as tweezers, adhesives or other products will be near my eyes. I agree that by reading and signing this consent, I release THE BABE CAVE and/or THE LASH ROOM from any claims or damages of any nature. I understand that I have requested and agreed to have lash and/or brow service(s) at THE LASH ROOM and/or THE BABE CAVE, and a trained professional will perform the service(s) to it's highest standard. If I experience an allergic reaction to lash extensions, I agree to contact my technician at THE LASH ROOM and/or THE BABE CAVE to have them removed at no charge, and I understand that a refund will not be provided for the original service.
I AGREE
I DISAGREE
Permission to use pictures
*
I agree and consent to "before + after" pictures of me, my face, and/or my eyes for the purpose of documentation, advertising, promotional and educational purposes. I further expressly assign any copyright in these photographs to THE LASH ROOM and/or THE BABE CAVE.
I AGREE
I DISAGREE
Emergency/Parent/Guardian contact information
*
Please provide the full name and phone number (including area code) of your emergency contact or parent/guardian if you are under 16 years of age.
Your Signature
*
I authorize the trained and certified lash professional of THE LASH ROOM and/or THE BABE CAVE at 155 Provencher Blvd, Winnipeg, Manitoba to perform my requested lash and/or brow services. A thorough explanation of the procedure, care and maintenance, and any procedural complications will be discussed with me. I will also be provided with and agree to follow aftercare instructions. By filling in your name below (your electronic signature), you verify that you have read, understand and agree to the above terms.
First Name
Last Name
Date
*
MM
DD
YYYY
Service(s) requested
*
Check all that apply.
Lash Extension Application/Removal
Lash Lift
Lash Tint
Brow Lift
Brow Tint
Henna Brow
Brow Shape
Lash + Brow Artist Name
Janis : THE LASH ROOM
TerraLynne : THE BABE CAVE
COVID-19 SCREENING
Do you or anyone you've been in contact with in the last 2 weeks have any cough, cold or flu-like symptoms?
*
No
Yes
Do you have shortness of breath at rest or difficulty breathing when lying down?
*
No
Yes
Do you have a new onset of any of the following symptoms: fever/chills, cough, sore throat/hoarse voice, shortness of breath, loss of taste or smell, vomiting, or diarrhea for more than 24 hours?
*
No
Yes
Have you or anyone you've been in contact with in the last 14 days tested positive for COVID or are awaiting results of a COVID test?
*
No
Yes
Are you or any of your close contacts awaiting COVID test results?
*
No
Yes
If your answer was 'yes' to any of the above, please cancel your appointment and reschedule when you are no longer feeling unwell. The health + safety of our guests, artists and neighbours is our top priority!
*
You may reschedule your appointment when you are no longer exhibiting any cough, cold or flu symptoms. By checking the box below, you verify that you have completed the above health screening questionnaire in its entirety and in truth.
I HAVE READ + COMPLETED THE COVID-19 SCREENING QUESTIONS ABOVE IN ITS ENTIRETY + IN TRUTH.
Thank you!
