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Name
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First Name
Last Name
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2
Date
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Date
Year
Month
Day
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3
The client has had the following services prior to coming to Luxe Color Lounge:
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4
Current Photo of Clients hair PRIOR to Correction
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5
Today's Visit Will Include the Following Steps and the plan for future visits (if needed) and the maintenance for this look:
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6
The price I have been quoted for my hair color service is:
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7
Colorist Signature
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8
Correction Terms and Conditions
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My current hair color has been compromised not by current salon, or I am making a dramatic change to my hair and therefore the stylist/colorist has explained that to get the final desired result the color has to be done in several separate visits. This is to ensure the condition of the hair is protected. I agree that I will be receiving the steps above and that the price I've been quoted is stated above. I understand completely that when I leave the salon today my hair will not look like the photograph I have shown as my desired finished look in one visit.
I understand that a small percentage of individuals experience adverse reactions due to application of hair color products. These reactions can include burning, redness, itching or swelling. Some people develop chemical burns on their scalp and hairline. Further, I have been informed via this form that a small percentage of individuals may react to hair coloring even though they have never had a reaction in the past with repeated applications. I know that a patch test, which determines whether or not I will experience a reaction to hair coloring can be giving by my colorist at Luxe Color Lounge. The patch test must be giving 48 hours or at least 2 days before my appointment for hair-coloring. I have read and understand all of the information above and I choose to forgo the patch test and direct Luxe Color Lounge Colorist to proceed with coloring my hair at this time. By signing this waiver, I hold harmless Luxe Color Lounge, its owners and employees from any liability arising from application of hair coloring products from this date forward.
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9
Client Signature
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