Patch TEST Consent FormS Patch test Consent Form Patch Test Form FULL NAME Date of Birth (DD/MM/YY) Contact No Email Patch Test Patch Test Please tick any that apply Please tick any that apply Tint Lash Extensions Lash Lift Hybrid Brow Tint Declaration Declaration I have been offered a patch test but have chosen not to understake it and to go ahead with the treatment at my own risk. I'll take a patch test, understanding that a successful completion of a patch test does not guarantee that an allergic reaction will not occur. I have read and understood the information provided. Today's date DATE FORMAT DD/MM/YY DATE FORMAT DD/MM/YY Technician's NAME 15 + 5 = Submit