Glue Test / Patch Test Consent Form - Velu-Beauty Brow and Wax

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

Please complete your personal and medical information accurately.

First Name

Last Name

Date of Birth (DOB)

Phone Number

Medical History & Conditions (Select all that apply)

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 / other info

Test Details

To be administered and completed by the technician.

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 & Disclaimer

Please review and confirm the following terms.

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 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

Please sign and date to authorize this consent form.

Client Signature

Date

Technician Name

Technician Signature