CONSULTATION & PATCH TESTING

Before carrying out any treatment, you should always carry out a thorough consultation.

The most important aspect of this is to ensure that it is safe to carry out the treatment. You should gather personal and medical information about your client, including whether they have any allergies or are taking medication. This should help you establish whether there are any contra-indications or contra-actions to treatment.

CONSULTATION FORM

NAME…………………………………………………………………………………… DATE OF BIRTH…………………

ADDRESS…………………………………………………………………………………………………………………………..

POSTCODE…………………………………………………. EMAIL………………………………………………………….

TELEPHONE NUMBER……………………………………………………………………………………………………….

MEDICAL HISTORY

Have you got any allergies?    YES/NO

DETAILS……………………………………………………………………………………………………………

Have you ever had an allergic reaction to any of the following?                   

 YESNODETAILS
TINT   
WAX   
LATEX/PLASTERS   
MASSAGE OILS   
PERM   
LASH GLUE   
ASPIRIN   

Are you currently taking any medication?

 YESNODETAILS
HORMONES   
WARFARIN   
CANCER TREATMENT   
ROACCUTANE   
BIRTH CONTROL   
SKIN TOPICALS   
HERBALS   
OTHER   

Do you have any of the following?

 YESNODETAILS
CANCER   
EPILEPSY   
HERPES   
SEIZURES / DISORDERS   
DIABETES   
AIDS/HIV   
HIGH/LOW BLOOD PRESSURE   
HEART PROBLEMS   

Do you have any other health problems or medical conditions?

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

I can confirm I have had a patch test and that I have had no reactions and that I am happy for my treatment to be carried out.

SIGNED…………………………………………………………………………..DATE………………………..………….

I certify that the above information is true and correct to the best of my knowledge. I am aware that it is my responsibility to inform my therapist of any changes that occur.

SIGNED…………………………………………………………………………..DATE…………………………………….

I give permission for ………………………………………………… To use any photos or videos taken during treatment on their social media platforms and websites for advertising purposes.

SIGNED…………………………………………………………………………..DATE…………………………………….

Patch Test

Sensitivity Patch Testing of Products & Following Manufacturer’s Instructions. You should always follow the specific manufacturer’s instructions on how and when to perform a sensitivity patch test (If one is required).

How to do a patch test

  • Use soap and water to cleanse a small area of skin behind the ear or on the inner surface of the forearm.
  • Apply the glue to the area you have prepared on your client.
  • The client should leave the products on their skin for 48 hours and then remove with soap and water.
  • If there is no irritation or inflammation in the area, then it is assumed that there is no hypersensitivity to the products.

A negative result on a patch test does not mean that the client will not react during treatment.

Patch tests should be performed regularly especially where clients may have not visited the salon in 6 months or had a change in health or medication. Sensitivity can occur at any point. If reaction occurs, then remove the product immediately and wash the area with water. Seek medical attention for your client.