Dees Beauty Salon
(Lash Lift & Tint • Lash Glue • Brow Tint)
IMPORTANT: A patch test must be completed at least 72 hours before your appointment at Dee’s Beauty Basingstoke.
This form confirms that the patch test has been carried out and that you understand the information provided.
Full Name:
Date of Birth:
Phone Number:
Email Address:
Lash LiftLash TintLash GlueBrow Tint
Date Patch Test Performed:
After the patch test, did you experience any of the following within 72 hours?
No reactionRednessItchingSwellingBurning sensationRashOther (please specify)
If 'other', please specify:
By submitting this form you confirm that:
You have received a patch test at least 72 hours before your appointment.
You have disclosed any reactions honestly and accurately.
You understand that a negative patch test does not guarantee that an allergic reaction will not occur during or after the treatment.
You agree to inform us immediately if you experience discomfort during the treatment.
You understand that Dee’s Beauty Basingstoke is not liable for any reactions.
Please inform us if any of the following apply:
Pregnant or breastfeedingKnown allergies / skin conditions (eczema, dermatitis)On medication that affects the skin
Name:
Date:
Signature:
