Tinting Consultation Card

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First Name

Last Name

Date of Birth

Age

Phone

Email

Address & Postcode

GP Name

GP Phone

Have you ever had an allergic reaction? YesNo

Have you had any surgery recently? YesNo

Do you take medication? YesNo

Do you have any broken skin? YesNo

Do you have any skin conditions pertaining to area being treated? YesNo

Have you been offered a patch test? YesNo

Do you accept liability to go ahead with tinting without patch test? YesNo

Are you pregnant? YesNo

Please Sign Here:

I have read, understood and agree with the before/after care instructions: Patch test is required 24 hours before your first tinting treatment, for lash tint please remove contacts and bring your glasses. Yes

I have read, understood and agree with the COVID-19 Policy Yes

I have read, understood and agree with the Terms & Conditions Yes

I have read, understood and agree with the GDPR Privacy Policy Yes