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PATCH TEST FOR PERMANENT MAKE-UP

The anaesthetic and pigment will be tested for sensitivity. The skin will be superficially pricked behind your ears and the anesthetic and pigment will be applied to the skin. After 24-48 hours your skin should be checked to see if there's any reaction.

If there is no reaction - no itching, redness, swelling or irritation, then it is safe to proceed with the treatment. Should you experience any of the above, the please clean the area of product immediately and contact the salon to advise of the results.

If there is no reaction, then you can go ahead with the procedure, as discussed.

During your pre-treatment consultation, the correct colour pigment will be mixed to check for the desired look and this will become the pigment patch test.

Location of test: Love Brows. 1914 Charlotte Ave. Nashville, TN 37203

I have undertaken a sensitivity patch test and have not suffered any adverse effects.

Today's Date: November 22, 2019

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information

Test date

Technician:
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*
Second Client's Date of Birth*
Second Client's Information

Test date

Technician:
Third Client's Name

First Name*

Middle Name

Last Name*
Third Client's Date of Birth*
Third Client's Information

Test date

Technician:
Fourth Client's Name

First Name*

Middle Name

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

Test date

Technician:
Fifth Client's Name

First Name*

Middle Name

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

Test date

Technician:
Sixth Client's Name

First Name*

Middle Name

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

Test date

Technician:
Seventh Client's Name

First Name*

Middle Name

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

Test date

Technician:
Eighth Client's Name

First Name*

Middle Name

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

Test date

Technician:
Ninth Client's Name

First Name*

Middle Name

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

Test date

Technician:
Tenth Client's Name

First Name*

Middle Name

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

Test date

Technician:
Parent or Guardian's Email Address

Email*

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Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Test date

Technician:
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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