New Client Intake Form

Thank you for choosing Bonita Lifts! We're excited to help you achieve your lash goals! Please fill out this form so we can customize your treatment to suit your needs. It’ll take just a few minutes! 🖤

CLIENT INFORMATION

First name

Last name

Email

Phone

Date of birth

Year

Month

Day

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact:

Name

Phone Number

How did you hear about us?

Social Media

Google

Referral

Other

CLIENT CONSULTATION

Which of these services have you received before?

Lash Lift

Tint

Lash Extensions

NONE

Were there any concerns/issues during or after service? (please describe)

If you've had a lash lift before, when was it? (approximately)

Do you have any allergies or sensitivities?

Yes

No

If YES, please list your allergies/sensitivities

Would you like a patch test performed 48 hours before your appointment to check for allergies?

Yes

No

*If YES - you will be contacted to book a patch test prior to your appointment*

Are you on any medications?

Yes

No

If YES, please list current medications

Do you currently use a lash GROWTH serum? (Revive 7, Grandelash, etc)

Yes

No

What best describes your daily makeup routine?

Full Glam – I wear makeup every day, including mascara, full foundation, and other products.

Light Makeup – I wear makeup every day but keep it natural and minimal (mascara, tinted moisturizer, etc.).

Natural Beauty – I prefer to go makeup-free or use only a few products.

How often do you wear mascara?

Everyday- I don't leave the house without it!

Occasionally

Rarely/Never

How often do you use a lash curler?

Everyday

Occasionally

Rarely/Never

What are your lash lift goals?

🌿 Natural and subtle: A soft lift that enhances my lashes for a naturally beautiful look.

🌸 In-between: A noticeable lift that's still elegant and balanced—just enough to make my lashes pop

💎 Bold and dramatic: A striking lift that makes my lashes stand out with a wow factor.

🌀 Not sure yet: I'd love to chat about the best option for my lash goals.

Is there anything else you would like to mention or any questions you have?

Optional: Help Customize your Lash Lift even further!

Upload a clear photo of your eyes so we can better assess your natural lashes and eye shape before your appointment. This helps us tailor the service to suit your unique features and achieve the best results.

Upload one photo of both eyes looking straight into camera, and one photo of eyes closed showcasing lashes

Tips for the Photo:

Ensure face is well lit, and taken in natural lighting if possible.
Capture eyes with no eye makeup/mascara and lashes NOT curled.

Uploading a photo is completely optional, but can help create the perfect lash lift for you and save time!

CLIENT CONSENT

Explanation of Service:

A Lash Lift is a semi-permanent treatment that enhances the natural lashes by curling and lifting them. A Tint darkens the natural lashes for a fuller, more defined look. Both treatments are designed to highlight your lashes while maintaining their natural health.

Do you consent to Bonita Lifts using photos or videos of you for marketing and social media?

Acknowledgment

I consent to have a Lash Lift & Tint for my natural eyelashes by Bonita Lifts

I acknowledge that the ingredients used include, but not limited to:

Toluene-2.5 Diamine Sulfate, M-Aminophenol, Castor Oil, Phenoxyethanol, Panthenol, Aloe Vera Extract, Chamomile Extract, Eucalyptus Extract, Essential oil fragrance, Hydrolyzed Collagen, Propylene Glycol, Hydrolyzed Keratin, Broccoli Extract, Glycerin, Hyaluronic Acid, Morus Bark Extract

I understand and Agree to the following:

Results may vary based on individual factors, and specific outcomes are not guaranteed.
Lash Lift & Tint services carry potential risks, including irritation, redness, discomfort, allergies, and, in rare cases, infections or blurriness.
The technician is not responsible for diagnosing allergies or sensitivities. I am responsible for disclosing all medical conditions, allergies, and sensitivities before treatment.
If I experience any adverse reactions, I will inform my technician and seek medical attention at my own expense if necessary.

I confirm I DO NOT have any of the following contraindications:

Pregnancy or lactation
Eye Infection or conditions (pink eye, stye, keratitis, blepharitis)
Glaucoma or other eye diseases
Recent eye surgery (within the last 6 months)
Recent semi-permanent makeup
Severe dry or sensitive eyes
Known allergies to products used in the service
Currently undergoing chemotherapy

I understand this consent applies to all future appointments unless I update my medical history or revoke it in writing

By signing below, I confirm that I am 18 years of age and that I have read, understood, and agree to the form outlined above.

Signature

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