A Spa to Remember | 3 Littleton Road Westford, MA 01886

( Do Not Confuse us with A Spa For You)


3 Littleton Rd Unit 1 | Westford, MA 01886

Westford/Chelmsford Line

(Formerly Of Chelmsford)

Please check Appointment Guidelines link before coming to your appointment it will help you understand the new procedures we need to follow.

A Spa to Remember Eye Lash and Brow Tinting Consent Form

    First and Last Name*

    Date of birth*




    Zip Code*

    Phone Number*

    Email Address*

    Would you like to receive weekly text messages of our specials?*

    Have you ever used hair color before?*

    Have you ever had an allergic reaction to hair color?*

    Do you wear contact lenses?*

    What over the counter or prescription skin care products are you currently using?*

    Do you have diabetes, lupus, or any auto-immune disease?*

    If yes, please describe

    Please list any illnesses or conditions you are being treated by a physician for*

    List any allergies you have*

    Have you ever had your eyelashes / eyebrows tinted?*

    If you had an adverse reaction to a previous tinting, please explain*

    Payment Information

    We require a 24-hour cancellation notice or appointment rescheduling of all services.
    A Charge of 50% of the service will be incurred for all missed appointments.

    Please note that this card will only be charged in the case of a same-day cancellation or a no-show appointment, please bring in a separate payment method at the time of your service.

    Type of card*

    Name on Card*

    Card Number*

    Expiration Date*

    CVC Number*

    Eye Lash and Brow Tinting Consent Form

    Although every precaution will be made to ensure your safety and well-being before, during and after your tinting, please be aware of the following risks below. Initial the following.*

    By entering your name, date and signature below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

    Sign Electronically in the empty space below:

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