Registration Form

Registration Form
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Parent/Guardian/Self Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Zip Code
# of People here Today?
# of People in the Family?
Are you a Blended Family with 2 or More households?

Name & Age of All Person(s) Being Screened/Treated Today

Rows	Name	Age
1
2
3
4
5
6
7
8
9
10

Have you been a client of ours before?
If yes, what name did you register under if different than the one listed?
Have you been treated or seen by another facility in the last 30 days?
If yes, what company?
How did you hear about us?
Please note: Our screenings are the most comprehensive in the area, however there are no guarantees associated with screenings. We stop our screening process after we find evidence of head lice. We’ll present the evidence to you, and you may decide how to proceed. You are not required to use our services for treatment. We offer a more comprehensive oil-based screening called a POM (Peace of Mind) ask your technician for the detailed information flyer about this service if you’re interested.This service is recommended for clients with an extensive amount of hair. There are no guarantees with a POM service.

At Let’s Be PALS, LLC, we understand the importance of providing quality care and treatment options for families dealing with head lice infestations. However, in certain situations, we reserve the right not to treat a particular family. This decision is made on a case-by-case basis, taking into consideration various factors such as safety concerns, non-compliance with our treatment protocols, or if the infestation is beyond our scope of expertise. Our utmost priority is to ensure the well-being and satisfaction of all our clients, and sometimes, it may be in the best interest of both parties to decline treatment.

We strive to communicate openly and honestly with families throughout the process, offering alternative resources or recommendations if necessary.

CLAIMER: Please be advised that the unauthorized photography or reproduction of our facility, paperwork, or any related materials is strictly prohibited. This includes, but is not limited to, capturing images or making copies without proper authorization from the concerned authorities. Additionally, we would like to inform you that all of our service plans and prices mentioned are subject to change without prior notice. While we strive to provide accurate and up-to-date information, circumstances beyond our control may necessitate modifications to our offerings or associated costs. While accessing or engaging with our facility, paperwork, or any associated materials, you agree to comply with the aforementioned terms and understand the implications of unauthorized photography or reproduction. We reserve the right to take appropriate legal action against any individual or entity found in violation of these restrictions. Thank you for your understanding.
Print Name (Parent or Guardian) Must Match ID
Signature

Who Are We Seeing Today?
Important Information for Your Appointment

We understand that every child is unique, and some may have sensory sensitivities or behavioral challenges, including discomfort with sitting still or having their hair brushed. Our team of professionals is skilled in working with children of all needs, and we’ll do our very best to ensure a positive experience. However, there are times when a child may be unable to complete treatment. In such cases, we’ll provide guidance and advise you on the best next steps to address their needs.For children with matted or tangled hair, please note that there may be an additional fee. Your child’s comfort and well-being are our top priority, and we’re here to support you every step of the way! If you have any questions or concerns, don’t hesitate to reach out before your visit. 😊
- 🎉 Fun Paks Are On Us for Treated Guests! 🎉
  
  Every treated superstar gets a FREE Fun Pak loaded with goodies! 🌟
  
  Want to spread the fun to others? You can grab a Fun Pak for siblings or friends not receiving treatment for just $3.99.
  
  🎁 Each Fun Pak is packed with:
  🍹 A refreshing drink
  🍬 Sweet candy treats
  👑 A crown or tiara (because everyone deserves to feel royal!)
  🎨 A cool temporary tattoo
  🧸 A fun toy surprise
  
  Let’s make this a day to smile about! 😊
- Please Click the "add row" button at the end until all persons in your party have been accounted for
- Should be Empty:

Registration Form

Who Are We Seeing Today?