Patch test Consultation Form

Lash extension patch test consultation form

A patch test will need to be done 48 hours before your lash appointment if this is your first time having your eyelashes done by Ren. This form is to be completed prior to the patch test appointment.

Name

First NameLast Name

Birth Date

MonthDayYear

Phone Number

Format: (000) 000-0000.

E-mail

Phone Number

Format: (000) 000-0000.

Health Information

Allergies

Are you currently pregnant or breastfeeding?

Please indicate if any of the following apply to you.

Please use this text box for additional relevant information and further information on allergies if any.

The patch test will consist of a couple of eyelashes being attached to your natural eyelashes. You must not get your eyelashes wet for 48 hours in order to complete the patch test. If your eyes become itchy, red, sore or swollen please contact me immediately as this will mean we cannot proceed with the treatment. Please note that I am not medically trained therefore you will need to seek medical advice if symptoms are severe.

Please note that allergies can still occur even if this patch test is negative. This is due to the fact that allergies can build up over time and a patch test does not give your eye lashes the full exposure like the full treatment. Allergies can even occur months after a number of treatments due to sensitivity over time.

Tick and confirm

I confirm that I have completed this form to the best of my knowledge and if there are any changes to medical and person information, I will inform my technician before any treatment is carried out.

Signature

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

Date

MonthDayYear