• 614 Hale, St. Ste. C Oxford, AL 36203
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Patch Test Consent Form

Patch Testing is a procedure for testing a customer's skin for any allergic reaction from a substance that is going to be used for the service that she desires to undergo. It involves placing an extension on both eyes, utilizing all products that will be used during the actual service and leaving it for around 24 to 48 hours for observation for potential reaction or effects which may include rashes, infection, or any skin irritation. Patch Testing is one of the classic methods for checking with a client to see if they will have any allergic reaction to any of the glues, creams or sealers that shall be used on them. This way, we can safely proceed with the procedure if no allergic reaction happens after 24-48 hours. Although a patch test is made, however, this is not a guarantee that the client will not have any further allergic reaction. It could take, days, months or years before one experiences adverse reactions.

The Patch Test A microfaom gel pad will be placed under the eye as a lower lash barrier. A primer will be applied that contains water, PVP, ethanol, alltantoin contains allantoin: comfrey herb extract, it is non-allergenic and moisturixing to your skin. The lash tech will then apply one extension per eye using a professional grade extension glue which contains carbon black, ethyl cyanoacrylate, hydroquinone and oly methyl methacrylate. A sealer will be used that contains water, alcohol, b vitamins such as sodium hyaluronate and allantoin, natural extracts, aloe leafe extract and xanthan gum. Thus, if you know that you have any allergic reaction to any of the ingredients, please notify us.

I hereby declare that I was recommended to undergo a patch test. It was explained to me the risks involved should I choose not to go with the patch test prior the procedure. I have had the opportunity to ask questions as well as relevant information regarding the patch test was explained to me to my satisfaction.

I understand that I must notify the technician in case any adverse effects happen after the treatment in order to receive proper instructions on the next measures to take.

I understand that in the case of an adverse reaction to my skin, I shall not hold the Natural Finish Lash Extensions LLC, Posche Salon LLC or the lash techs rendering the service legally liable or responsible for any internal or external damages to my physical body and personal belongings that may happen as a result of me receiving or not receiving the patch test. Nor will I seek monetary or disciplinary actions as a result of my decision.

*If you have already completed a consent form, please do not fill it out again for each visit.

Consent Patch Test(Required)
Name(Required)

Eyelash Service Waiver of Liability

By signing below, I am agreeing to the following:

I understand that by recieving the patch test 24-48 hours prior to my service. This has cleared me of having possible allergic reactions to the glue or lifting/perming solution which will allow me to receive eyelash extensions or a lash lift/perm.

Where eyelash extensions are concerned, I understand that because of the natural lash cycle and wear and tear, I will need to maintain my extensions with touch up appointments every 2-3 weeks to keep them full.

Where lash lifts/perms are concerned, I understand that the lift/perm will last up to anywhere from 4-6 weeks or it could last up to 3 months. As my lashes grow and fall out (the life cycle of lashes are about 60 to 120 days), the effects of the lash lift/perm become less noticeable.

I understand the aftercare instructions of my eyelash extensions or my eyelash lift/perm. I understand that if I am receiving extensions, I will need to keep my eyes closed throughout the lashing process as the lashes may stick together, causing them to bond together rather than one on one. I understand that if I am receiving a lash lift/perm, I will need to keep my eyeys closed throughout the lifting/perming process so that the products fo not enter my eye which may cause irritation.

I hereby release any and all persons representing this salon from all claims, demands, damages, actions and cause of action arising out of the performance of the service.

Name(Required)
I authorize (Chi Chi) to apply eyelash extensions or perform a lash lift/perm which may include tinting to myself. On this Pick a DateDate and future eyelash extension, eyelash lift/perm or eyelash tinting services.(Required)
I give consent for photographs and or videos to be taken of my lashes and used for the salon's use.(Required)

I certify that I completey understand and comply with the information stated above.

MM slash DD slash YYYY
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