sb-salon.co.uk
07300040002
02381 22 87 86
Mon-Sat : 09.00-20:00 |
Sun : 10:00-18:00
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Patch Test
Therapist Name
Alka
Priya
Seema
Eva
Location
Treatments client/i (client) receiving
Tint
Lash extension
Lash Lift
Brow Lamination
Waxing
facial
dermaplaning facial
henna tattoo
hair colouring
Client Details:
Client Full Name
Email (Optional)
Contact Number (Optional)
Date of Birth
AGE
Under 16
Under 18
18 or 18+
Parent/Guardian Details for under 18:
Name
Email
Contact Number:
Relation to the client:
Proof id client & parent id
❌
❌
Parent/Guardian Sign (Optional)
Parent/Guardian Sign Date & Time (Optional)
Client Health Details:
Are you currently taking, or have you previously taken, any medication?
Yes
No
Do you have any health issues, skin conditions, or allergies that may affect you ?
Yes
No
Have you recently or previously had any injuries or undergone any surgeries?
Yes
No
Are you pregnant?
Yes
No
If any of the health questions above are ''Yes'' please provide details here (If no leave it Blank):
Patch Test
AGE CONFIRMATION
I confirm that I am 18 years of age or older and legally able to consent to this treatment. If I am under 18 years of age and have attended with a parent or legal guardian, who has consented on my behalf.
Patch Test Recommended
I understand that a patch test is recommended and may be required before certain treatments (such as tinting, lamination, lash lifts, or hair colouring) to minimize the risk of allergic reaction.
No Guarantee
I understand that a patch test is not always 100% conclusive and a reaction may still occur despite a negative result.
Allergies Information
I have informed the salon of any known allergies, sensitivities, or medical conditions that may be relevant to this treatment.
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 any treatment(s).
Adverse Reactions
I understand that the salon cannot accept responsibility for any adverse reactions if I have chosen to refuse or waive the patch test.
Important:
If you experience any of the following symptoms after a patch test or treatment, You understand it is your responsibility to notify Seema’s Beauty Salon and contact a healthcare professional immediately: Swelling, Itching or burning, Redness or blistering, Difficulty breathing (call emergency services)
Patch Test Confirmation
Have you had the patch test?
Yes
No I Decline
Patch Test Date & Time (Optional)
Patch Test Refusal
If choose to decline the patch test, I accept full responsibility for any allergic or adverse reactions that may occur. I release the salon and its staff from any (and all) liability arising from my decision.
General condition
We are committed to providing a safe, respectful, and professional environment for all our clients and staff.
Right to Reschedule, Refuse, or Cancel Service
Our priority is to ensure a safe, respectful, and professional environment for both clients and staff. We reserve the right to reschedule, refuse, or cancel any appointment or service at our discretion for any valid and reasonable reason. This may include, but is not limited to Late arrivals, Health or hygiene concerns, Inappropriate behavior, Unsuitable client condition for the treatment, Staff availability or emergencies.
Reporting Misconduct
We maintain a zero-tolerance policy. Any serious misconduct will be reported to the appropriate authorities and may lead to legal action.
Terms and Conditions
By proceeding with this or any treatment at Seema's Beauty Salon, I confirm that I have read, understood, and agree to the full terms and conditions outlined on https://sb-salon.co.uk/terms-conditions/.
Acknowledge
By signing below, I(Client) confirm and acknowledge the following: You have read, understood, and voluntarily agree to the terms of this waiver. All information you have provided is true and accurate to the best of your knowledge. You were advised to undergo a patch test, and the risks of not having one were clearly explained. You had the opportunity to ask questions and received all relevant information about your treatment. The information was explained to your satisfaction and understanding.
Client Sign
Client Date & Time
SUBMIT
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