Hair Color Patch Test Disclaimer Form

Client Details

Patch Test

We require a patch test be performed 48 hours prior to any color/tint service(s). Please note that a negative patch test does not guarantee you will not have an adverse reaction to color/tint.

Please read the following information carefully:

Receiving any hair color service can, in some individuals, cause an allergic reaction.
This reaction can occur at any time even if I have received this service on previous occasions.
A negative skin patch test does not guarantee that a reaction will not occur.
These risks have been explained to me and if I have any concerns, I will seek medical advice prior to any color service.

Hair dye allergy symptoms include:
Stinging or burning sensation on the scalp, face, or neck
Blisters or welts
Itching or swelling of the scalp and face
Swollen eyelids, lips, hands, or feet
An angry, red rash anywhere on the body

Occasionally, a hair dye allergy will cause anaphylaxis to occur. This rare reaction is a medical emergency and can be fatal. 
Symptoms of anaphylaxis may include:
Skin reactions such as stinging, burning, swelling, and rashes Swelling of the throat and tongue
Trouble breathing

If you experience any of the above symptoms please seek medical advice immediately.


Tap or click on the signature area above to sign.
I have read and understood the information provided to me in this form.

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