Patch Test Declaration Form

    Basic Information

    • Name
      Please fill this in
    • Date of Birth
      Please fill this in
    • Mobile number
      Please fill this in
    • Patch test received?
      Please fill this in
      • Tint
      • Lash Lift
    Next
    Back

    Disclaimer

      Declaration 

      Please can you make sure all the information given above is correct, true and up to date. At the Norfolk Mead Hotel treatment rooms, we will not be held responsible for any consequences of being given false information or no information at all, which may affect specific treatments. All treatments are for general purposes and not intended for substitution of medical procedures. 

      Please note: We will never share your personal information with any 3rd parties and all information supplied will only be used for the purpose of your treatment, All personal information is only accessible to our Therapists and Reservation teams. You may view your personal file at any time via our Therapists. 

    • Date
      Please fill this in
    Back
Cookies

Cookies are small text files that are placed on your device to help ensure websites function correctly, as well as to provide information about users.

We have placed cookies on your device to help us improve our website.

To accept these cookies and continue browsing our website please click below.

Allow All Cookies

Allow Strictly Necessary Cookies Only

Read More