PATCH TEST QUESTIONNAIRE

Please answer the following questions and submit this questionnaire prior to having your patch test, also know as AAT (Allergy Alert Test) and thereafter at least 48 hours before each colour service.
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By Signing this form I confirm:

  • I am having my patch test today, and have never had an allergic reaction to PPD, Henna, hair colour, eye lash or brow tint in the past.

  • I am over 16

  • I have not had a new tattoo or black henna tattoo

  • I am not currently pregnant or breast feeding

Or

  • I am due to have a colour service in the next 48 hours and I have had a patch test within the last 6 months

  • I have not used a box/home colour since my last appointment.

  • I have not had a new tattoo or black henna tattoo since my last appointment

  • I do not want to change my colour result

  • I have not had any type of allergic reaction to anything at all since my last visit

  • I am not currently pregnant or breast feeding

By ticking this box you are agreeing to all the statements listed above on this questionnaire

Thanks for submitting!