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Get Bellavia Eyelash Extensions Intake Form

Nfirmations, quarterly newsletters, and to alert you of specials and promotions.) How were you originally referred to Bella Via? (Please circle and add note if applicable.) Dr. Colville Dr. Zavell Website Friend: Other: AREA SPECIFICS Is this the first time that you have had eyelash extensions applied? YES NO If no, where did you have them applied? Please indicate if you have worn any of the following types of eyelashes within the last 60 days: □ Individual □ Strip □ Flare □ Other Do yo.

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