Consent for a Patch Test
Hair dyes contain ingredients that can cause itching, swelling, and other allergic reactions. If the client has never colored their hair or doesn’t know what they’re allergic to, performing a “patch test” to check for symptoms is common.
A patch test involves applying a small amount of coloring product to the client’s skin and covering it with a patch. If any signs of an allergic reaction occur, an alternate product should be used instead.
The consent form offers an option to request a patch test. Clients who’d like to be tested should visit the salon at least 48 hours before their coloring appointment to have the patch test performed.
Sample
Download: PDF, Word (.docx), OpenDocument
HAIR COLOR CONSENT FORM
Stylist Name: [STYLIST’S NAME] Client’s Name: [CLIENT’S NAME]
Past Reaction to Color Products: [DESCRIBE PAST REACTION].
A small percentage of individuals can experience adverse reactions due to the application of hair color products. While rare, symptoms can include burning, redness, itching, and/or swelling. Due to the variety of ingredients used in hair color products, these symptoms may occur even if you have had your hair colored in the past with no reaction. Your colorist can administer a “patch test” to determine if you will experience a reaction to hair coloring. This test must be administered 48 hours prior to your appointment for coloring services. You have the right to request a patch test prior to every service at no additional charge to you.
Indicate below whether you would like the patch test performed: (check one)
☐ – I would like to have a patch test performed.
☐ – I would NOT like to have a patch test performed.
Is this service considered a “corrective” color? ☐ Yes ☐ No
Corrective color means:
- More time and expertise are required than with a standard color service.
- Reconstructive treatments may be needed prior to color services.
- Multiple visits will likely be required to achieve your desired color.
- Each subsequent visit will be a separate color service with separate charges applied.
- Specific products/treatments may be recommended to use at home to help guarantee color correction results.
Home Care and Products Recommendations: [LIST RECOMMENDATIONS].
Client Signature: _____________________________ Date: ________
Printed Name: _____________________________