Hair Extension Consent Form

Name *

First Name Last Name

Email *

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Date *

Date

Do you have any allergies? *

Yes, please list: No

I understand that hair extension services have some inherent risk of irritation and could result in but is not limited to: allergic reactions, pain, tender scalp. I understand that if I have an allergic reaction to any of the materials used that it is not the hair artist's fault and understand there are no refunds. *

Agree

I consent to “before and after” pictures for the purpose of documentation, potential advertising and promotional purposes. I also understand I have no rights to any photos/videos owned by One Stop Hot. *

Agree

I understand that if I have any concerns, I will address these with my technician. I give permission to my technician to perform the hair procedure we have discussed. I also consent to “before and after” pictures for the purpose of documentation, potential advertising and promotional purposes. I give permission to my technician to perform the extension procedure we have discussed, and will hold Sophia Stineman, One Stop Hot and her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically. I understand my hair specialist will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the hair specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the hair specialist responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today and hold One Stop Hot and Sophia Stineman harmless from any and all legal claims. *

Yes

I understand at One Stop Hot I am paying for my hair technicians time, skill and supplies therefore agreeing to their policy that they do not offer refunds. If I am unhappy with my service I will contact One Stop Hot and communicate that. *

I agree

Signature *

Clear