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M f <br /> LAI SAETERN <br /> Salon Allure 702 Porter Ave J Stockton ca, 95207 <br /> (209)684-26131 EYESDONTLAI@GMAIL.COM <br /> client information sheet <br /> NAME D.O.B_ <br /> ADDRESS CITY <br /> STATE ZIP <br /> CONTACT NO <br /> EMAIL <br /> May we contact you at these numbers if necessary? _YES _NO <br /> NO. OF VISITS REQUIRED: COST OF PROCEDURE(s): $ <br /> TOUCH UP FEE:_$ <br /> PROCEDURE(s) <br /> DESIRED: <br /> EYEBROWS EYEBROWS - HAIRSTROKE 3D <br /> EYEBROW (CORRECTIONS) <br /> OTHER (Please <br /> Explain): <br /> How did you hear about <br /> us? <br /> Were you referred by anyone? If so, please provide <br /> name: <br /> Are you currently under the care of a physician? YES NO <br />