About this template
Ensuring client safety is critical before performing beauty treatments like eyelash extensions, tints, or specialized skincare procedures. This Patch Test Form template allows salons, lash artists, and estheticians to screen clients for potential allergic reactions and medical sensitivities prior to their appointment. By gathering comprehensive health history, previous eye or skin problems, and specific allergy details, practitioners can minimize risks and provide a safe, personalized service.
Designed for seamless digital intake, this template replaces messy paper waivers with an organized online format that clients can easily fill out on any device before arriving. Salon owners and technicians can review responses instantly, ensuring compliance with safety protocols and safeguarding both the client and the business.
Key features
- Screen clients for allergies and sensitivities safely before treatment
- Collect detailed medical and eye health history in minutes
- Fully customizable questions tailored to specific salon treatments
- Mobile-friendly format for effortless client completion on any device
- Instant data organization for quick client record reviews
Use cases
- Pre-treatment allergy screenings for eyelash extensions and tints
- Client consultations for new skincare and chemical peel treatments
- Gathering signed health waivers prior to salon appointments
- Tracking client product sensitivities and reaction histories
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)We will use this to send you appointment confirmations and care instructions.
- Phone Number (Short answer)Enter your best contact number.
- Date of Birth (Date)Select your birth date.
- Applicable History Selections (Checkboxes)Check any medical conditions or sensitivities that currently apply to you.
- Have you ever experienced a reaction to eyelash extensions, glues, or tints in the past? (Multiple choice)Select your history with similar beauty treatments.
- Previous Eyelash Reaction Details (Paragraph)If you answered yes above, please describe the reaction, symptoms, and when it occurred.
- Recent Eye Problem Details (Paragraph)Describe any recent eye irritation, injuries, or infections within the last 6 months.
- Allergy Details (Paragraph)List any known allergies to latex, adhesives, cosmetics, metals, or medications.
- Max Lash Length Preference (Dropdown)Select your desired look or length style for your consultation.
- Client Acknowledgment & Consent (Multiple choice)By submitting this form, you confirm that the information provided is accurate and you consent to receive a patch test to screen for potential sensitivities.
FAQ
What is a patch test form and why is it necessary?
A patch test form collects essential medical history, allergy details, and consent from clients before applying lash extensions, tints, or chemical treatments to ensure they won't have an adverse reaction.
How can I share this form with my clients?
You can easily share your Google Form via a direct link in booking confirmation emails, via text message, or by embedding it directly on your salon's website.
Can I customize the questions for different salon treatments?
Yes! You can fully edit, add, or remove any questions in Google Forms to fit lash lifts, brow tints, hair coloring, or skincare procedures.
Is this template free to use?
Yes, this template is completely free to convert into a Google Form and use for your business.
Where are client form responses stored?
All client submissions are automatically organized in a connected Google Sheets spreadsheet, making it easy to review records before each appointment.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.