Patch Test Form - New Colour

In accordance with manufacturers guidelines, if you are a new colour client that has not already completed a patch test with us, or an existing client looking to change colour, you will require a patch test. Please complete the form below to proceed.

Client's Personal Information

If any of the following questions are answered 'yes' we cannot colour your hair unless you first get advice from your doctor.

If any of the following are answered YES, we will proceed with your patch test. If all are answered NO, we do not need a patch test.

Allergy Test Record Information

Please select one of the following, depending on whether a patch test is required and will be completed or not.

I do not require a patch test to be completed today as a result of earlier selection answers. This means that I have not had any allergic reactions to any products since I last coloured my hair, nor have I had any skin tattoos including henna or permanent make up. I confirm it has been less than 12 months since my last patch test and less than 6 months since my last colour. I am a regular client to this salon / hairdresser and I am having the same shade as my existing colour.

I agree for a patch test to be completed today. I fully understand this risks and potential adverse effects and reactions that can occur due to patch testing / hair colouring, and understand why this patch test is required. I understand that it is my responsibility to follow all instructions given to me by my hairdresser in terms of the development time, removal and waiting period of the patch test, and also that It is my responsibility to inform my hairdresser of any reactions or adverse events that I experience. I also acknowledge that my hairdresser is following the patch testing procedure in accordance to manufacturer's instructions as required by law and insurance providers. I agree not to hold my hairdresser responsible for any adverse affects or reactions to the patch test."

Name and of Product Used - Product/Shade/Developer

Todays Date

Type Full Name as Signature

Name of Hairdresser

Thanks for submitting!

07449 933126

Patch Test Form - New Colour

Client's Personal Information

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