No Patch Test Consultation Form

No patch test consultation form

This form is required if a patch test has not been carried out by Ren. This is if the client has had the treatment done before or is happy to proceed without a patch test.

Name

First NameLast Name

Birth Date

MonthDayYear

Phone Number

Area CodePhone Number

E-mail

Health Information

Do you have any medical history I should be aware of?

Do you have any allergies I should be aware of?

Are you currently pregnant or breastfeeding?

Read all statements and tick the last one to confirm all

Signature

Sign by using a touch tablet/screen or left click and hold as you sign with your mouse.

Date

MonthDayYear