Aura Consent Forms

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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)

CONSULTATION INFORMATION. Please indicate if you have (or have had) any of the following
Allergies	Yes No	Alopecia/hair loss	Yes No
Blepharitis	Yes No	Cataracts	Yes No
Conjunctivitis	Yes No	Contagious disease	Yes No
Diabetic retinopathy	Yes No	Dry eye syndrome	Yes No
Eczema	Yes No	Eye infection/cyst/stye	Yes No
Glaucoma	Yes No	Hay fever	Yes No
Hives	Yes No	Hormone imbalances	Yes No
Hypersensitive skin	Yes No	Lice	Yes No
Menopause	Yes No	Psoriasis	Yes No
Rosacea	Yes No	Sensitive eyes	Yes No
Seizures	Yes No	Skin or eyelid infection/disorder	Yes No
Trichotillomania	Yes No	Weak/brittle lashes	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 presently undergoing any medical treatment?	Yes No
Are you pregnant or nursing?	Yes No
Do you wear contact lenses?	Yes No
Have you received lash services before?	Yes No
Have you been in direct sunlight for any period or have you used a tanning bed or tube within the last 24 hours?	Yes No

Treatment Card: Level Enhance Lashes

Personal / Contact Details