Client Patch Test Consultation Form

Lash Lift/Brow Lamination/Henna Brows/Brow Tint Patch Test Consultation Form

This form is required if a patch test is being carried out by Lashour for a client who has never received one of the treatments before. This form must be complete prior to the appointment.
Name*

First NameLast Name
Email*
example@example.com
DOB*
Where did you hear about Lashour?*
Phone Number*

Area CodePhone Number
Treatment Type*
IMPORTANT INFORMATION WHEN GETTING A LASH LIFT, BROW LAMINATION AND/OR HENNA BROWS

Please read...
Brow Lamination/Lash Lift

A patch test for a lash lift and brow lamination consists of putting 4 solutions behind the ear. These are;

1) Lifting cream
2) Neutralising cream
3) Moisturising serum
4) Tint

These solutions will need to be left on for a minimum of 24 hours. If they are to become itchy, red and sore please notify me straight away as this could mean you have had a reaction to one of these solutions. If this is the case the treatment cannot go ahead.

Henna Brows/Brow Tint

A patch test for Henna Brows consists of putting the Henna solution/Tint behind the ear also and this will need to be left on for a minimum of 24 hours.

Please bear in mind this does not give a clear indication of whether a reaction will occur or not. This is because of 2 reasons:

1. A patch test does not give full exposure in the same way as the full treatment.
2. Allergies are cumulative, meaning they build up over time.

It is more likely for allergies, sensitivities, and reactions to occur after you have been having these treatments for 6 months or more. This is because sensitivity will build up each time you are exposed to these solutions.

This means that a patch test will not accurately test for allergies and a reaction could still occur even if the patch test results are negative.
Please use this text box for allergies or additional information you believe would be important for your therapist to know
Once you have read and understood the above and given all necessary information, please read and tick the following statements to confirm you understand:
I have read and understood the information regarding patch testing.I have been offered the option of a patch test. I will be going ahead and having a patch test before the treatment appointment.I accept there may be a risk of an adverse reaction to this treatment including the possibility of swelling, irritation and rednessI understand an adverse reaction can happen at any time and not necessarily after the initial treatment.I understand that if any of these reactions occur I should contact my technician immediately. If symptoms persist, I must seek medical attention.I understand that in the case of a reaction I will not hold my technician responsible in any way. This includes any of the reactions specified above and/or any other reactions I may have.
CONSENT:

I can confirm that I have completed this form to the best of my knowledge and understand that if there are any changes to my medical or personal details I will make my technician aware before any treatment/s are carried out.
(Client Signature)*

Clear
Should be Empty:

Lash Lift/Brow Lamination/Henna Brows/Brow Tint Patch Test Consultation Form

IMPORTANT INFORMATION WHEN GETTING A LASH LIFT, BROW LAMINATION AND/OR HENNA BROWS

Once you have read and understood the above and given all necessary information, please read and tick the following statements to confirm you understand:

CONSENT: