Glue Test / Patch Test Consent Form - Velu-Beauty

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TINT TEST / GLUE TEST CONSENT FORM

TINT TEST / GLUE TEST CONSENT FORM

This form must be completed and signed by all clients prior to undergoing eyebrow tinting, eyelash tinting, eyelash extensions, or lash lifts. Tint and glue tests are required a minimum of 24–48 hours before the treatment.

CLIENT & MEDICAL DETAILS

Name

Date of Birth (DOB)

Phone

Email

Checkbox Field

Dry Eye Syndrome

History of medical conditions (e.g. Diabetes, Cancer, HIV, Asthma)

Conjunctivitis

Allergic to plasters/products

Pregnant / Breastfeeding

Known allergies (e.g. nuts)

Any previous eye complaints

Other info therapist should know

Details of previous eye complaints / allergies

TEST DETAILS

Type of Test (Select all that apply)

Tinting (Eyebrow/Lash)

Glue (Eyelash Extensions)

Lash Lift

Product

Batch No

Expiry Date

Test Time

Area Tested

OBSERVATIONS (24–48 hrs post-application)

To be completed 24-48 hours after the patch test

Test Result

No reaction noted

Redness or swelling

Itching or irritation

Other (please specify)

Other Observation (if applicable)

CLIENT DECLARATION

Please confirm all of the following:

I understand allergic responses may occur later, and I must notify the therapist of any reaction before treatment

I acknowledge that lash treatments may require maintenance and carry minor risks including premature lash loss.

I take full responsibility for lash choices agreed during consultation, and understand proper aftercare is essential.

I confirm I’ve received the relevant aftercare advice sheet.

PATCH TEST DISCLAIMER

Patch Test Agreement

I understand this patch test is being carried out to detect possible sensitivity or reaction. I will only book my treatment 24 hours after this patch test and will notify the therapist of any signs of discomfort.

I have been offered a patch test but decline and choose to proceed with treatment. I accept full responsibility for any reaction

SIGNATURES

Client Signature

Date

Technician Name

Technician Signature

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+1(437) 989-7567, +1(647) 986-2117
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VELU BEAUTY

📍Unit 50 Georgetown Market Place 280 Guelph St., Georgetown, Ontario, L7G 4B1

🕒Mon – Sat: 10:00 AM – 7:00 PM
Sunday: 10:00 AM – 4:00 PM

📞 +1(437) 989-7567, +1(647) 986-2117
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Serving Georgetown, Halton Hills and surrounding areas.

Our Services

Brow Lamination in Georgetown | Velu Beauty
Best Facial in Georgetown, ON | Professional Skin Care Treatment
Foot Massage
Henna Tattoo
Lash Extensions in Georgetown | Velu Beauty
Relaxation Massage
Threading in Georgetown, ON
Tinting
Professional Waxing in Georgetown, ON
Kaansa Body Detox

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Brow Lamination in Georgetown | Velu Beauty
Best Facial in Georgetown, ON | Professional Skin Care Treatment
Foot Massage
Henna Tattoo
Lash Extensions in Georgetown | Velu Beauty
Relaxation Massage
Threading in Georgetown, ON
Tinting
Professional Waxing in Georgetown, ON
Kaansa Body Detox

Customer Resources

Location
n
Client Forms
Contact Us

Menu

Location
n
Client Forms
Contact Us

Policies

T&C
Refund Policy
Privacy Policy

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