AuraLuxe Patch Test Consent Form

(Valid for 3 Months)

Patch tests are required at least 48 hours before the following treatments: Brow Tint, Lash Tint, Lash Lift, Brow Lamination, Waxing (face/body). Patch tests are valid for 3 months unless your health/products change. If you have any reaction, do not proceed — contact us.

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Patch Test Details

Which treatment are you being patch tested for?

When is your appointment date?

When was this patch test applied?

Which product system(s) were actually used for your patch test?

Brow Code Tint + Brow Code Oxidant — brow/lash tint

AURA Monaco Step 1 & Step 2 — lash lift / brow lamination

ELAN Hybrid Tint — hybrid brows

Italwax Luxury Full Body Wax — film wax for brow/facial/intimate/body waxing

Italwax Cartridge Flex Lipsoluble Wax — Raspberry roller wax for legs/arms/back

Who applied the patch test

Alexis Courtney

AuraLuxe Staff Member

Where was the patch test applied?”

Behind ear

Inner elbow/forearm

Near brow area

Other (short answer)

Have you had any reaction in the test area within 48 hours?

Safety Screening

Have you had any allergic reactions to beauty products in the past?

Do you have asthma or breathing difficulties triggered by chemicals/scents?

Do you have autoimmune conditions or are you immunocompromised?

Are you currently taking antibiotics, Roaccutane/isotretinoin, blood thinners, steroid medication/creams, or any medication that affects healing/skin sensitivity?

Skin conditions / sensitivity

Do you have broken skin, sunburn, rash, abrasions, or irritation in the area to be treated?

Have you had a chemical peel, microdermabrasion, microneedling, laser, or strong retinol/acid skincare recently?

Have you used retinol / tretinoin / glycolic / salicylic in the last 7 days on the area being treated?

Eye / lash specific (only relevant to lift/tint/lamination)

Do you currently have any eye infection/irritation (conjunctivitis, stye, watery/itchy eyes)?

Have you had eye surgery in the last 6 months?

Do you wear contact lenses?

Yes

No

If Yes: “You’ll need to remove them for the treatment — do you agree?”

Yes

No

Wax-Specific Screening

Have you ever reacted to waxing (redness lasting >24hrs, swelling, blistering, bruising, skin lifting)?

Are you using or have you recently used:

Acknowledgement

I understand patch-test timing depends on the product used and current manufacturer instructions, and AuraLuxe will advise me when my test must be completed.

I understand a new patch test may be required if the product system changes or if my health, medication, allergies, skin or eye condition changes.

I agree to inform AuraLuxe immediately if I experience any reaction.

I understand if I have any reaction, my treatment may be refused for safety.

Todays Date

Signature

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AuraLuxe Patch Test Form