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)

Do you have any allergies?	Yes No
Are you on any medication?	Yes No
Have you had any exposure to the sun or extreme heat in the last 48 hours?	Yes No

Medical History

Consent and Disclaimer

I have been made aware of all complications that could occur with my treatment, such as redness for 48 hours, scabbing lasting for up to 2 weeks, skin sensitivity, skin burn, and infection in the skin pigmentation. I agree not to take any legal action if I experience any complications or I am not happy with the treatment. We do not offer any refunds.

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.

Lupus or auto-immune deficiency	Yes No	Blood Thinning medication	Yes No
Pregnancy	Yes No	Chemical peel, laser or skin resurfacing	Yes No
Blood abnormalities	Yes No	Herpes or fever blisters	Yes No
Steroids -in the last 3 months	Yes No	Diabetes	Yes No
Keloid Scarring	Yes No	Epilepsy	Yes No
Psoriasis or vitiligo	Yes No	Scars that turn white or brown	Yes No
Pulmonary embolism/ blood clot	Yes No	HIV	Yes No
Transplant anti-rejection drugs	Yes No	Hepatitis	Yes No
Leg ulcer or phlebitis	Yes No	Hemophilia	Yes No

Removal of Skin Tags / Milla / Moles / Red veins / Hair

Personal / Contact Details

Medical History