New Client Consultation Form

Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I understand that if a minor is receiving services, a parent or guardian must remain with the minor throughout the entirety of the service.I understand that children are not allowed in the work service area, if they are not being serviced, for safety reasons.I understand that EYNB Trichology has the right to refuse service to anyone that is not respectful or may pose a threat to the owner (Tiffany Dixon) or the establishment (EYNB Trichology).I understand that booking fees, to secure an appointment, are non-refundable.I understand that if I am more than 15 minutes late to my appointment, I will need to reschedule and my booking fee will be forfeited.I understand that if I cancel the appointment I scheduled, less than 48 hours before the scheduled appointment time, my booking fee will be forfeited.I understand that ALL sales are final once service is rendered. (Trichology services and hair styling services.)I understand that services scheduled outside of normal business hours will incur a convenience fee of $100.

I give consent to EYNB Trichology to take photograph(s) and/or video(s) of my or my minor dependent's hair care and hairstyling journey, hair progression, along with microscopic hair and scalp photograph(s) and/or video(s). (You may choose below in what form the photographs and/or videos will be shared)I give consent to EYNB Trichology to share my or my minor dependent's photograph(s) and/or video(s) on their website, social media platforms, tangible and virtual advertising materials for promotional use, gallery portfolio, and/or testimonials.I understand there will be NO financial compensation nor any other form of compensation for taking, using, or sharing my or my minor dependent's photograph(s) and/or video(s).

Face CAN be shown when using/sharing photos and/or video(s).NO face showing when using/sharing the photograph(s) and/or video(s).

Photos/Videos are taken for the purpose of documenting your haircare journey from start to finish and also of hairstyles that you choose to enhance your appearance.

New Client Consultation Form

Medical History

Do you now or have you:

Is Your Scalp:

Habits

WOMEN ONLY

POLICIES

Photo/Video Release