HOLD SALON – COLOUR ALLERGY (PATCH) TEST CONSENT FORM
Name
First Name
Last Name
Email
Phone Number
Please enter your phone number
Allergy & Health Questionnaire
Please answer the following questions honestly:
Has it been 6 months or more since your last colouring service or allergy test?
Please Select
YES
NO
Are you under the age of 16?
Please Select
YES
NO
Have you ever had an allergic reaction to hair colourant?
Please Select
YES
NO
Have you had an allergic reaction to a henna tattoo?
Please Select
YES
NO
Since your last colour service, have you had an allergic reaction to any other hair products?
Please Select
YES
NO
Do you currently have a damaged or irritated scalp?
Please Select
YES
NO
Do you have a known allergy to any nuts?
Please Select
YES
NO
Do you have a known allergy to lavender?
Please Select
YES
NO
Marketing Preferences Would you like to hear about HOLD Salon special offers and updates?
Please Select
Sms
E-mail
No thank-you
Client Declaration
I confirm that the information I have provided is accurate to the best of my knowledge. I understand this test is necessary to minimise allergic reactions to hair colour services, and that I must wait a minimum of 48 hours before any colour service can be carried out.
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Day
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Year
Date
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