Patch Test Form

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Patch Test Form

You must be over 18 years of age to complete this form. If you are under 18 years of age, a parent/guardian must complete this form on your behalf, plus the Parental Consent Form.

Why élégant nails need the information and how it is used:

At élégant nails, I take your privacy seriously. For health and safety of clients, I maintain records of any health and/or medical conditions, which may indicate that a particular service or treatment would not go ahead (eg allergies, pregnancy, skin conditions), or a particular product should not be used.

Please note that this form must be kept for a minimum of 7 years from your last treatment for insurance purposes and require clients to complete and submit this form before any treatment takes place. In the case of minors, this will be 7 years after they reach the age of 18.

Clients records from this form are stored on the secure Cloud on Google Forms or on an encrypted computer. Please read the privacy policy at https://elegant-nails.co.uk/policy-documents for more details.

The health records are only used in relation to treatments and service by élégant nails and not used for any other purpose.

Email *

Patch Testing Statement:

As a professionally run home and mobile salon, your safety will always come first. The following information applies to any Eye Enhancement treatment offered by élégant nails.

The vast majority of people can use products designed to enhance the eyes with no problems or side effects, a small number of people will experience adverse reactions.

As it is possible to develop an allergy, even if you have had eye enhancement treatments in the past with no problems. It is a requirement to perform a patch test with élégant nails before your first eye enhancement treatment, if new products are used and every 6 months thereafter.

Patch tests MUST be carried out at least 48hrs in advance of any treatment. To confirm with safety and insurance policies, it is a requirement that you complete the form below to the best of your ability.

If you have a reaction to a patch test, you must seek medical advice before proceeding with a treatment.

Patch Test(s) required: *

LASH LIFT (Airlift Fixing Gel, Lifting Lotion, Setting Lotion)

EYEBROW LAMINATION (Airlift Fixing Gel, Lifting Lotion, Setting Lotion)

LASH and/or BROW TINT (Combinal Tint, Hydrogen Peroxide)

HENNA BROWS (Supercilium Brow Henna, Rose Water)

EYELASH EXTENSIONS (LashArt Black Adhesive)

Required

CLIENT CONSENT (Please tick each statement to confirm you understand the advice to be followed after your treatment): *

I understand the information regarding patch testing;

I have been offered the option for a patch test and agree to the patch test before the treatment is carried out;

I accept there may be a risk of an adverse reaction to this treatment, including the possibility of swelling, irritation and redness;

I understand an adverse reaction can happen at any time and not necessarily after the initial patch test and/or treatment;

I understand that if any of these reactions occur before the treatment, I should contact my technician immediately;

If a reaction occurs after treatment, I should contact my technician immediately who may request I come back in for a removal procedure and I shall not remove enhancements myself;

I understand that in the case of a reaction, I will not hold my technician responsible in any way, as the test has been carried out with my consent (this includes any of the reactions specified above and/or any reaction I may have).

Required

Is there anything that you’d like to make élégant nails aware of before attending your Patch Test appointment? *

I can confirm that I have completed this form to the best of my knowledge and understand that if there are any changes to my medical or personal details, I will make my technician aware before further treatment is carried out.

I understand that if I do not complete my Patch Test 48hrs minimum before my treatment(s), my appointment will automatically be cancelled.

Full Name: *

Parent/Guardian Name (if required):

Contact Number: *

Date of completion: *

YYYY

A copy of your responses will be emailed to the address you provided.

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