New Client Form

New Client Form

Hair Consultation and Consent

Date

MonthDayYear
Today’s Date
Name

First NameLast Name
Gender
Ex: Male or Female
Date of Birth
Month/Date/Year
Phone Number
Please enter your valid phone numberFormat: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
First & Last Name, Phone Number, and Relationship to Contact

How did you hear about me?
Ex: Instagram, Facebook, Tik Tok, Friend, Family? Etc.

Medical History
Ex: Pregnant? Medications? Conditions or Illnesses? Hair loss, Alopecia, Eczema? Allergic to anything? Etc.
Hair History
(In the last 5 years) Ex: Color- Professional or at home box dyes? If at home color was used, what brands? Have treatments, perms, or any other chemical services been done previously? Etc.
What products are you using on your hair currently?
Ex: Brands/types of shampoo and conditioners, heat protectants, leave in conditioners, styling products, finishing products? Etc.

What are you interested in having done?
Ex: The type of service? Is this your first time getting yourself professionally done and if not, why are you changing hairstylist/what didn’t you like about your last one?
What are your top concerns about your hair?
Ex: Oily, dry, damaged, frizzy, flat, volume, thickness, thinness? How do you like it fixed/styled? How often are you willing or planning to be in the salon for maintenance? Do you have a budget and if so, what is it?

Current Hair Picture

Please insert the best quality photo as possible
Cancelof
Inspiration/Reference Picture

This needs to be a realistic picture based off the conditions of your hair currently. An inspiration picture is most of the time just used for reference and not so much as an exact duplicate of how your hair will turn out unless your stylist says otherwise
Cancelof

What is your schedule preferences?
Ex: Weekends vs Weekdays and AM vs PM?

Hairstylist Servicing
I, blanks, hereby consent to receive hairstyling services from Madison Rose Beauty (Madison R. Latiola) at any location designated by the hairstylist.
I am aware that the services provided by the hairstylist can potentially involve some risks. These may include, but are not limited to: allergic reactions to hair products, hair breakage or damage, and irritation or sensitivity of the scalp or skin. I confirm that I have openly and fully disclosed to Madison Rose Beauty (Madison R. Latiola) all relevant medical history, hair history, and any other important health-related information that could affect hairstyling services. I will communicate openly with the hairstylist about my preferences, expectations, and any concerns I may have. I understand that communication is crucial to achieving the desired results.

Color Corrections (If Any)
I acknowledge that my natural hair color pigment that has been bleached, dyed, or otherwise altered by any type of product/chemical has been done by myself at home or in another salon. This has resulted in a color correction service. I acknowledge that the color correction sessions that I am having done to my hair can further damage it. Madison Rose Beauty (Madison R. Latiola) will preform the color correction service with the understanding that the damage and any other color or chemical processes occurred to the clients hair before the client came to Madison Rose Beauty (Madison R. Latiola), and processed and possibly damaged, color correction may not be 100% achievable to total satisfaction to the client. In fact, it might take more than stated number of visits to accomplish, if possible, the desired results. Madison Rose Beauty (Madison R. Latiola) will try to achieve the results desired to best of her professional ability.

At Home Care
I understand that Madison Rose Beauty (Madison R. Latiola) will recommend at home care products to help maintain my hair color, haircut, treatment, or any other chemical services for the overall health of my hair. This will ensure the longevity and quality of the finished results. If I decide to not purchase these products, I am acknowledging that my color or treatment may not stay in the same condition nor as healthy.

Liability and Pricing
I hereby release, waive, and discharge Madison Rose Beauty (Madison R. Latiola) from any and all claims, demands, damages, complications/outcomes, or any other causes of action that may arise as a result of the hairstyling services provided to me. I understand the pricing and payment terms for the services, as communicated to me by the hairstylist.
Photo Release
I, blanks, hereby grant permission to Madison Rose Beauty (Madison R. Latiola) to use photographs taken during my appointment for the purposes outlined blow. I understand that the photographs taken by the stylist may be used for promotional, marketing, and advertising purposes. I grant permission for the stylist to use the photographs for an indefinite period unless otherwise agreed upon in writing. I understand that I may revoke this consent at any time by submitting a written request to the photographer. I understand that I will not receive any compensation for the use of the photographs. I release the stylist from any claims, damages, or liability arising out of the use of the photographs, including any distortion, alteration, or use in composite form, whether intentional or otherwise, that may occur during processing or publication. I have had the opportunity to review the stylist’s previous work and understand the style and quality of their work. I am granting this consent willingly and without any pressure from the stylist. The stylist will not disclose any sensitive personal information along with the photographs without obtaining my explicit consent.
Parental/Guardian Consent (Minors-under the age of 18)
At Madison Rose Beauty (Madison R. Latiola), I take pride in my ability to provide a thorough consultation for beginning any hairstyling services. Although I offer a baseline pricing and do my best to estimate charges and time, things unseen might result in additional costs. In order to avoid confusion, I strongly encourage parents to be present during the consultation process and ask any questions about the possibility of additional charges for any services being done on their children before they are started. I, blanks, give consent for my son/daughter to have the desired services done by Madison Rose Beauty (Madison R. Latiola). I understand that once these services are complete, I am liable for payment.
Date of Service blanks
Client’s Name blank
Parent or Legal Guardian’s Name   First Name   Last Name
Signature of Legal Guardian’s Name   Signature
Today’s Date   Date
Cancellation/No Show Policy
In order to ensure the provision of high quality care within a reasonable timeframe, I have implemented an appointment and cancellation policy. As appointments are in high demand, cancelling your appointment in advance allows me to offer the time slot to another individual seeking timely care. This policy helps me to optimize your appointment availability for all clients. I understand that circumstances may arise requiring you to cancel or reschedule your appointment. However, if a cancellation/no show within a 24 hours’ notice occurs without any rhyme or reason, a 50% fee will be required to pay. Sickness or emergency is the only acceptable reason that will not be required to pay that fee. If the fee is required by me and you resist to pay, you will no longer be allowed to book with me moving forward. This is my career and not just a hobby. No clients means no money is made because we literally pay to work. I will always respect your time as long as you respect mine. Thank you so much for choosing me to be your cosmetologist!

Final Agreement Consent
I am aware that this consultation and consent form will be maintained on record by Madison Rose Beauty (Madison R. Latiola) and will remain valid until I decide to revoke it. By signing below, I hereby acknowledge that I have completely read and fully understand the above consultation and consent agreements. First Name Last Name
Signature

Should be Empty: