Wufoo

AAM Migration Survey

Please complete this survey on eyeliner pigment migration.

First Name
Last Name
email address
Your Telephone: Cellphone preferred - (###) - ### ####
Have you ever had pigment migration after eyeliner? Yes No
What is the name of the pigment you used?
Who makes the pigment?
Describe your case of migration
How did you handle your problem with migration?
Is there a lawsuit? Yes No Not yet I've notified my insurance company I've refunded her money
Who is your insurance company?
Write your questions or comments here
Do Not Fill This Out