🧪
Beauty & Personal Care
Patch Test Consent
Capture client details, allergy history, and informed consent before a colour or chemical patch test — required 48 hours before many colour services.
Use this template12 fields · Free · Customize before publishing
What this form looks like
Preview · not interactivePatch Test Consent
Capture client details, allergy history, and informed consent before a colour or chemical patch test — required 48 hours before many colour services.
Client details
Full name*
Email address*
Phone number*
Date of birth*
Pick a date📅
Colour services require clients to be 16 or older.
Planned colour service*
Select…▾
Health & allergy history
Do any of these apply to you?*
Known allergy to hair dye (PPD or similar)
Latex allergy
Very sensitive or reactive skin
Skin reaction to hair or beauty products in the last year
Describe any allergies or reactions
Have you had a patch test with us before?*
Yes — within the last 6 months
Yes — more than 6 months ago
No — this is my first patch test
Patch test consent*
Patch test consent
Signature*
Sign here
Submit