Patch Test Consent Form Trace Patch Test consent form Name * Name First Name First Name Last Name Last Name Email * Date of birth * Address * Address Address Address City City County County Postcode Postcode Treatment type * Korean lash lift LVL lash lift Eyebrow lamination Brow wax and tint Skin type * Normal Dry Oily Sensitive Combination Skin concerns Relevant medical issues or allergies (especially cosmetics, adhesives or dyes) Patch test checklist * Step 1 – lifting lotion applied Step 2 – Setting lotion applied Step 3 – lash tint applied Step 4 – areas successfully covered with tape All must be checked off to send the form. Checklist confirmation * Client Acknowledgement & Aftercare InstructionsI acknowledge that the patch test has been applied as indicated above.I agree to leave the patch test on my skin for a full 24 hours without washing, rubbing, or removing the tape. I understand that if I experience any adverse reactions, such as redness, itching, burning, swelling, or irritation, I must remove the tape and products immediately, cleanse the area thoroughly with cool water, and report the reaction to my practitioner right away. I understand that a positive reaction means I am not a suitable candidate for a Korean Lash Lift. I fully understand this statement. Client signature * signature keyboard Clear Date * Practitioner signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
