Patch Testing Consent Form

You must ensure your client completes a patch test form prior to administering a patch test. This will keep you safe if they were to have a reaction to any pigments or numbing topicals you may use.

I can confirm I (clients name)……………………………………. agree to (your name) …………………………………………………………. administering numerous patch tests in preparation for my microblading procedure. I release any liability from the artist …………………………………………………… and (company) ……………………………………… if any of the patch tests result in a positive reaction. I understand it is my decision to withgo these tests to ensure my safety during the microbalding procedure but understand this does not mean I cannot still have a reaction during the microblading procedure.

I (clients name) ………………………………………… agree to the following tests:

Pre Numbing Cream (on the skin)

Secondary Numbing Cream (inserted into the skin using a lancet)

Pigment (inserted into the skin using a lancet)

Aftercare Ointment (on the skin)

If agree to inform (your name) …………………………………………… straight away if any of the patch tests result in a positive reaction such as Swelling, Redness, Rashes, Hives, Puss, Opened skin. I agree I have been given contact details by my artist in such events.

Client Name: ………………………………………………………………………

Client Signature: …………………………………………………………………

Artist Name: ……………………………………………………………………….

Artist Signature: ……………………………………………………………………………………………….