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Scar & Stretch Mark Patch Test Consent Form

Patch Testing involves applying a small amount of pigment to the target area and monitoring for any adverse reactions over 48–72 hours. This test helps identify potential sensitivities or allergic responses before proceeding with full treatment.


Please note: While a patch test can help detect certain allergies, it does not guarantee that a reaction will not occur in the future. Possible side effects include localized redness, rash, itching, infection, or delayed hypersensitivity.


Pigment ingredients may include: Iron Oxide, Titanium Dioxide, Isopropyl Alcohol, Glycerin, Ethanol, and Distilled Water.


Choose One of the Following Options:

I have received a patch test on the date below and understand the potential risks associated with pigment use. I release NueVeil, Kelly Pegni, and any assistants from liability related to allergic or adverse reactions. I ackno
I consent to the Patch Test
I elect to proceed without a patch test and release NueVeil, Kelly Pegni, and any assistants from any liability should I develop an allergic or adverse reaction during or after my procedure(s). By declining the patch test, I assume all associated risks.
I waive the Patch Test
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