LUMIERE BEAUTY

HAIR COLORING CONSENT & PATCH TEST FORM

Client Name

Date of Birth

Phone

Appointment Date

1. IMPORTANT — MANDATORY PATCH TEST
Hair coloring requires a patch (skin sensitivity) test before the color service. A small amount of the relevant hair-color product is applied to a suitable small area of skin according to the product manufacturer's instructions. The test must be completed in advance and checked within the required time. For many hair dyes, safety guidance uses a 48-hour test period; Lumiere Beauty will follow the specific product manufacturer's instructions. If a reaction occurs, the color service must not proceed with that product. A negative patch test does not guarantee that a reaction cannot occur during or after the full service.

Patch test status

Completed Reaction/Positive — DO NOT PROCEED Not completed — COLOR SERVICE CANNOT PROCEED

Patch test date/time

Product/Color tested

Result

No visible reaction Redness Itching Burning Rash/Swelling Other

2. Hair Color Service

Service

Full Color Root Color Highlights Balayage Toner/Gloss

Color/Brand

Desired Result

Additional Products

Bleach/Lightener Developer Toner Other

3. Client Health & Hair History

• Have you previously reacted to hair color, bleach, henna, cosmetics, or other chemical products?

Yes No

• Have you ever had a black henna tattoo or known sensitivity to PPD or hair-dye ingredients?

Yes No

• Your scalp currently irritated, sunburned, broken, infected, or unusually sensitive?

Yes No

• Have you recently had bleaching, coloring, perming, straightening, relaxing, or other chemical hair services?

Yes No

• Do you have any known allergies or sensitivities that the stylist should know about?

Yes No

• Are you currently using any medication or treatment that may affect your scalp or skin?

Yes No

If you have any question, please provide details :

4. Possible Risks & Limitations

Temporary scalp or skin irritation, itching, burning, redness, dryness, or sensitivity
Allergic or sensitization reactions, which can occasionally be serious
Hair dryness, brittleness, breakage, or changes in hair texture, particularly after lightening or bleaching
Uneven or unexpected color due to previous color, treatments, hair condition, porosity, or other factors
The requested color may require more than one appointment and/or may not be achievable without compromising hair condition
Results may fade or change over time depending on hair type, products, washing routine, and aftercare

5. Client Acknowledgement & Consent

I confirm that I have provided accurate information about my allergies, previous reactions, scalp condition, hair history, and recent chemical treatments. I understand that a patch test is required before hair coloring and that the service will not be performed if the required patch test has not been completed or if a reaction is observed.

I understand that a patch test cannot completely eliminate the possibility of a reaction. I have had the opportunity to ask questions and understand the possible risks, limitations, and expected nature of the service.

I agree to immediately inform my stylist if I experience burning, itching, swelling, pain, breathing difficulty, or any unusual reaction during or after the service.

6. Patch Test & Service Record

Patch Test Performed By

Date

Patch Test Product/Code

Time

Result/Notes

Approved

Yes No

7. Signatures

Client Signature

Date

Stylist Name

Signature

Safety note: Hair-dye reactions can occur even after previous successful color services. Follow the manufacturer's instructions for the specific product used, including the required skin test and timing.

This is a general salon consent template and should be reviewed against the actual products, manufacturer's instructions, salon procedures, and applicable local legal/regulatory requirements before use.

LUMIERE BEAUTY

HYDRAFACIAL TREATMENT CONSENT FORM

Client Name

Date of Birth

Phone

Treatment Date

1. About the Treatment

A HydraFacial is a non-invasive facial treatment that may combine cleansing, exfoliation, gentle extraction, and hydration using specialized skincare products. The treatment is intended to improve the appearance and feel of the skin. Results vary between individuals and are not guaranteed.

2. Possible Temporary Effects

Temporary redness, sensitivity, tightness or mild swelling
Mild tingling or irritation during or after treatment
Temporary dryness or peeling
Temporary skin sensitivity, especially after exfoliation or extraction
Breakouts or changes in skin appearance in some individuals
Rarely, allergic or adverse reactions to products used during treatment

3. Please Inform Your Therapist If You Have:

Known allergies or sensitivities to skincare/cosmetic products
Active skin infection, open wounds, severe irritation, or significant inflammation
Cold sores or a history of recurrent cold sores
Recent facial procedures, chemical peels, laser treatments, microneedling, or other resurfacing treatments
Recent use of prescription or strong topical skincare products, including retinoids or exfoliating acids
A current sunburn or significant recent sun exposure
Any other condition, medication, treatment, or concern that may affect your skin or the suitability of the treatment

4. Client Health & Skin Questionnaire

Do you have any known allergies?

Yes No

Are you currently using prescription skincare?

Yes No

Have you had a facial/peel/laser treatment recently?

Yes No

Do you currently have irritated or broken skin?

Yes No

Are you pregnant or breastfeeding?

Yes No

Other relevant information

5. Client Consent & Acknowledgement

I confirm that I have provided accurate and complete information about my health, skin, allergies, medications, and recent cosmetic treatments.

I have had the opportunity to ask questions about the HydraFacial treatment and understand its nature, expected benefits, limitations, and possible temporary risks or reactions.

I understand that individual results vary and that no specific result has been guaranteed.

I agree to inform my therapist immediately if I experience discomfort or an unusual reaction during the treatment.

I understand that the therapist may postpone, modify, or decline the treatment if it is considered unsuitable or unsafe for me.

6. Aftercare Acknowledgement

I understand that I may receive aftercare guidance following my treatment and agree to follow the recommended skincare instructions.

I understand that avoiding excessive sun exposure and using appropriate sun protection may be recommended after treatment, depending on my skin and the products used.

7. Signatures

Client Signature

Date

Therapist Name

Signature

Important: This form is a general client-consent template and should be reviewed and adapted to the actual products, equipment, protocols, and legal/regulatory requirements applicable to Lumiere Beauty and the location where the treatment is provided.