Lash client intake, contraindication and patch test record

Eyelash Extension Technician | PublicProof Academy working document

Non-editable educational sample of record categories. Not an approved clinical form or treatment protocol. A qualified professional must review suitability before use in their own secure system.

Business

State or jurisdiction

Prepared on

Owner

Official source saved

Next review

Client and appointment

Client name
Date of first consultation
Phone and email
Emergency contact
How the client found you
Service requested (classic / hybrid / volume / mega / lift and tint)

Contraindication screening - any yes means stop and refer

Eye surgery, LASIK or eyelid procedure in the last 6 months
Current conjunctivitis, stye, blepharitis, dry eye or eye infection
Known allergy to cyanoacrylate, latex, medical tape or adhesives
Chemotherapy, radiation or immunosuppressive treatment now or recently
Alopecia, trichotillomania or recent lash loss of unknown cause
Use of lash growth serum, retinoids or prostaglandin eye drops
Pregnancy-related sensitivity the client wants to flag
Contact lenses worn today
Previous reaction to lash extensions anywhere

Patch test

Patch test performed on (date and time)
Adhesive brand, batch and lot number used
Location of patch (outer corner / behind ear)
Client instructed to report redness, itching, swelling within 24 hours
Result recorded at (date and time)
Result: no reaction / reaction - service declined
Minimum 24 hours elapsed before full set booked

Service record

Date of service
Set type, curl, diameters and lengths used
Adhesive brand, batch and lot
Time in chair
Photos taken with written permission (yes/no)
Anything unusual noted during service

Aftercare acknowledgement and signatures

Aftercare sheet given and explained
Client understands no oil-based products on the lash line
Client understands to cleanse daily with lash-safe cleanser
Client understands not to pick, pull or use a lash curler
Client understands to contact a healthcare provider for any eye symptom
Rebooking date agreed
Client signature and date
Technician signature, licence number and date

Use rule: Education and organization only. Record the agency, official source, checked date, cost, proof saved and responsible person for every consequential requirement. Unknown means stop and confirm. Example rows are labeled EXAMPLE and are not your data.