FULL NAME

Date of Birth (DD/MM/YYYY)

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.

DD/MM/YYYY

Technician's NAME