Non-Patch Test Consultation Form
This form is required if a patch test has not been carried out by Lashour, because the client has had the service done before and would like to not go ahead with a patch test. It must be complete prior to the appointment.
Full Name
*
DOB
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Where did you hear about Lashour?
*
Select Treatment
Eyelash Extensions
Lash Lift
Lash Lift & Tint
Brow Tint
Brow Lamination
Brow Lamination and Tint
Henna Brows
SPMU Ombre Brows
Do you have any allergies or medical history I should be aware of? (Optional)
Are you pregnant? If Yes, please advise what trimester you are in below
Please Select
Yes
No
Trimester (optional)
Please read, tick and confirm you agree and understand
I have been made aware of the option for a patch test
I do not wish to have a patch test before the treatment is carried out.
I can confirm that I am aware of lash adhesive/perming/tints/numbing agents/pigment reactions and sensitivities.
I accept there may be a risk of an adverse reaction to the selected treatment(s), including the possibility of swelling, irritation and redness.
I understand an adverse reaction can happen at any time and not necessarily after the initial treatment.
I understand that if any of reactions occur, I should contact my technician immediately who may request I come back in for a removal procedure and I shall not remove the lashes myself. If symptoms persist, I must seek medical attention.
I understand that in the case of a reaction, I will not hold my lash technician responsible in any way, this includes any of the reactions specified above and/or any other reaction I may have.
(Client Signature)
*
Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: