sb-salon.co.uk
07300040002
02381 22 87 86
Mon-Sat: 9:00-20:00
Sun: 10:00-18:00
Parking
Directions
Share
Google
Facebook
Instagram
Book at Millbrook
Book at Totton
Menu
Home
Our Services
Threading
Brow Lamination & Tint
Manicure
Pedicure
Acrylic Nails
Lash-Lift
Lash Extensions
Body Waxing
Body Massage
Henna
Facials
Contact
Jobs Apply Now
Blog
Offers
Menu
Home
Our Services
Threading
Brow Lamination & Tint
Manicure
Pedicure
Acrylic Nails
Lash-Lift
Lash Extensions
Body Waxing
Body Massage
Henna
Facials
Contact
Jobs Apply Now
Blog
Offers
Book at Millbrook
Book at Totton
PATCH TEST+ DISCLAIMER
0. Patch Test Setup
0.1 Therapist
Select therapist
Seema
Deep
Alka
Priya
0.2 Treatments Slot
0.3 Treatments
Select treatment(s)
Tint
Lash extension
Lash lift
Brow lamination
Waxing
Henna tattoo
0.4 Form Refer (Auto)
1. Client Details
1.1 Name
*
1.2 Contact
*
1.3 Email
*
1.4 D.O.B
1.5 Age category
*
Select age category
18+
80+
Under 18
2. Guardian / Emergency Contact (Optional)
2.1 Name
2.2 Contact
2.3 Relation
2.4 Under 18: guardian authority & consent
I confirm I am the client’s parent/legal guardian, I have authority to consent on their behalf, and I consent to the patch test / treatment.
3. Treatment History & Reactions
3.1 Have you had this treatment before?
*
Select
No
Yes
3.2 If Yes: where did you last have it?
3.3 Reaction to similar products/treatments?
*
Select
No
Yes
3.4 If Yes which products?
4. Client Health Details
4.1 Are you on any Medications?
*
Select
No
Yes
4.2 Health issues / skin conditions / allergies
*
Select
No
Yes
4.3 Injuries/surgeries*
Select
No
Yes
4.4 Are you pregnant?
*
Select
No
Yes
4.5 If you answered “Yes” to any health question: provide details
*
5. Patch Test, Consent & Conditions
5.1 Patch Test Status
*
Select
Yes - Patch test completed
No - I decline the patch test
5.2 Patch Test Date
5.3 Patch Test Time
5.4 AGE CONFIRMATION:
I confirm I am 18+ and legally able to consent, OR if under 18 I am attending with a parent/legal guardian who has consented on my behalf.
5.5 PATCH TEST RECOMMENDED:
I understand a patch test is recommended and may be required before certain treatments (eyelash lift, eyelash extension, tint, waxing, brow lamination, henna, facial) to minimise the risk of allergic reaction.
5.6 NO GUARANTEE:
I understand a patch test is not always 100% conclusive and a reaction may still occur despite a negative result.
5.7 ALLERGIES INFORMATION:
I have informed the salon of any known allergies, sensitivities, and relevant medical conditions.
5.8 RESPONSIBILITY:
I understand it is my responsibility to contact the salon and seek medical advice if I experience any unusual reaction following a patch test or treatment(s).
5.9 IMPORTANT SYMPTOMS:
If I experience swelling, itching/burning, redness/blistering, or difficulty breathing, I will notify Seema’s Beauty Salon and contact a healthcare professional immediately (for breathing issues, I will call emergency services).
5.10 PATCH TEST REFUSAL (IF DECLINING):
If I choose to decline the patch test, I accept responsibility for allergic/adverse reactions that may occur. I understand the salon may refuse, reschedule, or restrict treatment for safety/insurance reasons.
5.11 AFTERCARE DELIVERY:
I understand I will receive a confirmation email and relevant aftercare guidance for the treatment(s). If I do not receive it before leaving, I will request another copy, or I will request a hard copy before leaving the salon.
5.12 AFTERCARE QUESTIONS:
I will request clarification before leaving if I have any questions about aftercare advice.
5.13 AFTERCARE RESPONSIBILITY:
I understand aftercare is my responsibility and results may be affected if advice is not followed. I understand the salon is not responsible for adverse outcomes where relevant information was not disclosed or aftercare advice was not followed.
5.14 PRIVACY & RECORDS:
I understand my information is recorded for treatment history, safeguarding, and insurance purposes, stored securely, and retained only as long as necessary.
5.15 DUTY TO UPDATE:
I confirm I have disclosed all relevant information and I will inform the salon of any changes before any appointment/treatment.
5.16 PLACEHOLDER EMAIL:
If I choose not to provide my own email address, I authorise the salon to use a placeholder email (e.g., no-email@client.com) solely to submit and securely store this form.
5.17 DOB LIMITS:
If I do not provide my date of birth, I understand age verification and safeguarding checks may be limited. The salon may request ID or refuse/restrict treatment for safety, legal, insurance, or safeguarding reasons.
5.18 PHOTOS FOR RECORDS:
I consent to photos being taken before and/or after the patch test/treatment for record-keeping and treatment documentation (where applicable).
5.19 RIGHT TO RESCHEDULE/REFUSE/CANCEL:
We reserve the right to reschedule, refuse, or cancel any appointment/service for valid reasons including late arrivals, health/hygiene concerns, inappropriate behaviour, unsuitable client condition, or staff availability/emergencies.
5.20 ZERO-TOLERANCE / MISCONDUCT:
We maintain a zero-tolerance policy. Serious misconduct may be reported to the appropriate authorities and may lead to legal action.
5.21 TERMS & CONDITIONS:
By proceeding with this or any treatment at Seema’s Beauty Salon, I confirm I have read, understood, and agree to the full Terms & Conditions.
5.22 ACKNOWLEDGEMENT:
I confirm all information provided is true/accurate. I was advised about patch testing and risks, had the opportunity to ask questions, and I voluntarily agree to this form.
5.23 MASTER ACCEPTANCE:
I confirm I have read and understood all statements in Section 5 above and I agree to them. By ticking this box, the related acknowledgements will be selected for convenience.
6. Signature
6.1 Client signature
*
6.2 Print name
*
6.3 Sign Date & Time
6.4 Staff notes
WhatsApp us