Confidential Case Study Form

If you would like to report a possible reaction to hair colour please complete this form.

Email SupportTeam@colourstart.co.uk if you would like more information about how this form is used.

Name: *

Email:*

Date: *

We would like to start by confirming the information we hold about you on Colourstart Passport is correct

Is the email address above the one used for your Colourstart Passport?

If not, please enter the email address you used:

Is the application and removal time recorded on your Colourstart Correct?

Is the result you gave on your Colourstart Passport correct?

Are you sharing your Passport with the salon who carried out your recent colour service?

We would like to know more about your professional hair service

Date and time of service

Date:

Time:

We would like to know some basic information about your adverse experience following your professional treatment

How long after the application service did you experience discomfort?

How would you describe the discomfort?

What were (are) the symptoms (check all that apply)

RednessSwellingHeatBlistering

Other please describe

Are you still experiencing these symptoms?

If you are no longer experiencing these symptoms, how long after first experiencing them did they stop?

We would like to know if you have been receiving any healthcare treatment for your symptoms

Have you seen a pharmacist or a GP for advice?

Have you received treatment?

If you answered yes above, please describe your treatment:

We would like to know some more about your previous experiences with allergy

Have you previously experienced an allergy to hair colour at home or in a salon?

Have you previously had a black henna tattoo?

Have you been diagnosed with any skin allergies?

Please add any other comments you think may be important for us to know.

Please attach up to 3 photos if required:

How it works

Colourstart can show whether someone may be allergic to one of the ingredients, called PPD, used in hair colorants. Find here a step by step guide to how to use Colourstart and how Colourstart works.

Help and advice

Here you can find lots more useful information and advice on who should use Colourstart and how it should be used.

Buy

You can buy Colourstart from any participating Colourstart hair or beauty professional.

Find a ColourStart Salon