Fillable Consult Questionaire
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  • Format: (000) 000-0000.
  • In Case of Emergency whom shall I contact        . Phone Numb        .

  • HISTORY OF HAIR AND SCALP HEALTH

  • HISTORY OF HAIR STYLING

  • HEALTH HISTORY

  • I understand it is my responsibility to communicate with my medical provider before adding any supplements with current medications. I understand that Kerri’s recommendations should not be a substitute for medical advice by my physician. By agreeing to these terms, I further understand that results will vary depending on a large number of factors and I acknowledge that it is my responsibility to inform my Hair Loss Specialist/Trichologist & Dr. of any changes in my condition, no matter how slight.

    I understand that if I need to cancel or reschedule my appointment, a 24 hour notice must be given by text, phone call or via online booking reminders. I understand that there will be no fee if I cancel 24 hours of my scheduled appointment. 
    If for any reason I do not cancel or reschedule my appointment I understand that I will be charged 50% of my scheduled service total and may not reschedule until that fee is paid.

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