Onyx Lash Studio

Intake

This form completes your treatment file. We only ask what is needed to treat you safely. Your answers go directly to the studio and nowhere else, and are kept according to the retention period in the privacy statement.

Name *

E-mail address *

Phone number *

Date of birth *

Address

Desired treatment *

Have you had this treatment somewhere else before?

Health

Answer every question with yes or no. A yes does not automatically mean the treatment cannot go ahead; we discuss it together.

Do you have an eye infection or blepharitis?

Do you wear contact lenses?

Have you had eye surgery or laser eye treatment in the past 6 months?

Do you use eye drops for glaucoma?

Do you use a lash serum?

Have you had chemotherapy or do you have alopecia?

Are you allergic to glue (cyanoacrylate), latex, henna or tint?

Are you pregnant?

Have you had a patch test? If yes: when and what was the result?

Is there anything else I should know?

I have read and understood the information about the treatment, healing and aftercare, and consent to the treatment. Read more here.

I give explicit consent to keep the health details from this form for my treatment file, 5 years after my last treatment. Read more here.

Photos of my treatment may be used anonymously for portfolio and social media.

I would like to receive occasional tips and news by e-mail.

Signature

Full name (typed) *

Date: 16/09/2026