Tint Patch Test Consent Form (Remote) | Webform Portal

Tint Patch Test Consent Form

Full Name: *

Date of Birth: *

Email: *

I understand that it is an insurance requirement to have a patch test at least 24 hours prior to full treatment taking place.

I understand that there are certain risks and side effects associated with tinting, and in some individual cases can cause an allergic reaction.

I understand that this reaction can occur at any time even if I have had this treatment on a previous occasion.

I have received a patch test on the date below. The patch test releases (Company Name) from any liability related to any allergies or other reaction to applied pigments.

Date of patch test: *

Client Signature: *

Tap or click on the signature above to sign

Patch test completed by:

Therapist Signature: *

Set a reminder:

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