Aura Consent Forms

Personal / Contact Details

Name

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Date of Birth (dd/mm/yyyy)

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Email Address

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Phone Number

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Postcode

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Address

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Therapist

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Patch Test All of our products undergo extensive testing in line with industry standards and comply with all applicable requirements to ensure that they are safe. However a person's reaction to any product is personal to them and products of any kind can cause allergy or other reactions.
We strongly recommend that all of our customers participate in a skin sensitivity test at least 48 hours prior to the full application of any product, to reduce the risk of an adverse reaction, even if previously used. However, you are responsible for your own safety and it is your decision as to whether you wish to participate in a test or not. Please tick the box applicable to you below, then sign and date this Consultation Form to confirm your understanding of this.
I have undergone an allergy/skin sensitivity test. I do, however, acknowledge that applying any product to the skin or hair is never entirely without risk.

Patch Test Date (dd/mm/yyyy)

Medical Information

Do you have/have you had any of the following:
Skin condition around the eye area	Yes No	Lack of sensitivity around the eye area	Yes No
Epilepsy	Yes No	Eczema	Yes No
Dermititis	Yes No	Eye infection/infalmmation	Yes No
Styes	Yes No	Blepharities	Yes No
Cysts in eye area	Yes No	Dry Eye Syndrome	Yes No
Eyelid surgery	Yes No	Cataract	Yes No
Glaucoma	Yes No	Hayfever	Yes No
Diabetic Retinopathy	Yes No

I confirm that the above information is correct, to the best of my knowledge. I understand that the Therapist is relying upon this information to provide a safe and effective treatment. I take full responsibility for any information I have not given correctly and will undergo a patch test at least 48 hours prior to the treatment. I authorise the below named Therpist to perform the treatment of Semi-Permanent Eyelash Extensions on myself as detailed overleaf. I understand that infill treatments will be required to maintain the appearance of my lashes and that additional charges apply. I have received aftercare advice.

Consent Form: Disclaimer

I understand a patch test is required before I have the above treatment due to a possible reaction to the product or glue. However, I am prepared to take full responsibility with this disclaimer and will not pursue any action against the therapist or salon should there be any reaction what so ever. No refunds will be given.

Please accept Disclaimer.

Are you currently receiving treatment from a Medical Professional?	Yes No
Are you currently taking prescribed medication?	Yes No
Do you have any allergies or are you sensitive to any products?	Yes No
Have you ever had an allergic reaction to adhesive or tape?	Yes No
Do you wear contact lenses?	Yes No
Are you under the age of 18?	Yes No

Eyelash Extension Consultation

Personal / Contact Details

Medical Information