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Patch Test Consent
A short record of your patch test. Please read the two confirmations at the end.
Full name
*
(required)
Email address
*
(required)
Phone number
*
(required)
Date of the patch test
*
(required)
What was tested?
*
(required)
Select…
Hair colour
Brow or lash tint
Lash adhesive
Lamination solution
Henna
Other
Product or brand, if known
Which service is this for?
*
(required)
Select…
Hair colour
Brow treatment
Lash treatment
Other
Date of your appointment, if booked
History
Have you ever reacted to this kind of product?
*
(required)
Select…
No
Yes
Not sure
Any skin conditions, allergies or medication we should know about?
Confirmations
I will contact you immediately if I notice any reaction, and will not attend the appointment until we have spoken
*
(required)
I understand that a patch test reduces but does not remove the risk of a reaction
*
(required)
The information above is accurate
*
(required)
Leave this field empty
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