Patch Test Record Card

Structured card to document patch tests with product details, batch numbers, results and client signatures.

BeautyKiln Document Hub - Patch Test Record Card - Free to use, no attribution required

Patch Test Record Card

Business name: _______________________________________________

Client Details

Patch Test Record

Allergy / Sensitivity History

Does the client have any known allergies? Yes / No

If yes, list: _______________________________________________

Has the client had a previous reaction to any hair or beauty product? Yes / No

If yes, describe: _______________________________________________

Is the client currently taking any medication that may affect skin sensitivity? Yes / No

If yes, list: _______________________________________________

Is the client pregnant or breastfeeding? Yes / No

Important Notes for the Practitioner

• Patch test at least 48 hours before treatment. Some manufacturers and insurers require 72 hours. Check your product instructions.

• Test behind the ear or on the inner elbow. Use a small amount of the actual product you will be using, mixed to the same strength.

• Record the batch/lot number. If there is a reaction, you need to know exactly which product and batch caused it.

• A new patch test is needed if: the client has not been treated for 6+ months, you are using a different product or brand, the client reports a new allergy or medication, you are using a new batch of the same product (some insurers require this).

• Failure to patch test is the number one reason insurance claims are denied in hair and beauty.

• Keep patch test records for at least 7 years after the last appointment.

• If a client refuses a patch test, do NOT proceed with the treatment. Record the refusal and the reason. Your insurance likely will not cover you if you skip the patch test.

Refusal to Patch Test

I have been advised that a patch test is required before _______________________________________________ (treatment type).

I understand the risks of proceeding without a patch test, including allergic reaction, and I choose not to have one. I understand that _______________________________________________ (business name) cannot proceed with the treatment without a completed patch test.

Client signature: ___________________________ Date: _______________

Practitioner signature: ___________________________ Date: _______________

TREATMENT MUST NOT PROCEED IF THIS SECTION IS SIGNED