Eyelash Patch Test Consent Form

First name*

Last name*

Email*

Phone*

Address*

Medical & Allergy History:

Have you ever had an allergic reaction to eyelash extensions, tint, glue, or skincare products?*

Yes

Do you have sensitive skin or eyes?*

Yes

Do you wear contact lenses?*

Yes

Do you have any eye conditions (e.g., conjunctivitis, blepharitis, styes)?*

Yes

Are you currently taking any medication or under medical care?*

Yes

Do you have any known allergies (latex, adhesives, etc.)?*

Yes

Other:

PATCH TEST DECLARATION:

PATCH TEST DECLARATION*

I agree to have a patch test performed at least 24–48 hours before my lash service.

I decline a patch test and understand that I may be at risk of an allergic reaction.

I acknowledge that by declining a patch test, I am fully responsible for any adverse reactions that may occur during or after the treatment. I release the salon and technician from all liability related to such reactions.

Client Declaration & Consent:

Signature (type full name):

Signature (Enter Full Name)*

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Date:

Date:*

Metaglamorsys

+44 07985200574

beautycontact@metaglamorsys.com

London, UK

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