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Forms

MIRAGE Salon & MedSpa

Lash Lift and/or Lash Tint Consent Form

Patient Information

SECTION 1: ACKNOWLEDGMENTS AND AGREEMENTS

Previous discomfort, stinging and adverse reactions please check all that apply:
Are you Pregnant or Nursing?
Yes
No
Are you taking HRT?
Yes
No
Have you had eyelash or brow tinting, eyelash perming, eyelash extensions or semi-permanent mascara applied previously?
Yes
No

SECTION 2: CONSENT

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