Exhale Spa East Patch Test

First name

Last name

Date

I am being patch tested (AT LEAST 48HOURS PRIOR - LASH LIFT IS NOT SUITABLE DURING PREGNANCY OR BREASTFEEDING) for:
LASH LIFTLASH TINTBROW TINTLASH GLUE

Other

Have you had a previous allergy? If you tick yes you are unable to proceed with this treatment.
YESNO

If you have a reaction to the patch test within 48 hours please contact the salon. We will not be able to proceed with any treatments if a reaction occurs.
I understand that successful completion of a patch test does not guarantee an allergic reaction will not occur and I have chosen to undertake this treatment at my own risk.

I agree that all information is correct and by ticking this box and entering my full name below I give permission for the treament to be given

I accept that any treatment I have taken is at my own risk. I certify that i have read and completed the above to the best of my knowledge. I understand that failure to disclose information requested above may result in adverse side effect, unknown because of this to which I accept full liability/responsibility

Disclaimer
I fully understand the above concent/permit and treatment/s to be carried out. The undertaken of the treatment/s has been fully explained to me. I accept full responsibility for this and or other complications which may arise or result during or following any procedure that is performed at my request.