New Client Intake and Consent Form

  • New Client Intake Form

    Studio 512
  • Today's Date*
     - -
  • Date of Birth (15% off during birthday week)*
     - -
  • How did you hear about us?*

  • Have you seen a Dermatologist for scalp issues in the past year?*
  • Do you have or have ever had any of the following?*

  • Any known allergies*
  • Have you ever had an adverse reaction after using any hair care product?*
  • If yes, please check all that apply:

  • Are you pregnant or post partum?
  • What do you consider your scalp/hair type?*
  • What hair care products do you currently use?*

  • In the last 18 months, have you had any of the following?*
  • What services are you interested in?*
  • How often would you prefer to come in for maintenance appointments?*

  • Customize Your Experience

  • Essential oil preference*
  • Silent Appointment

  • By SUBMITTING AND SIGNING THIS FORM, I acknowledge, consent and agree to the following:

    I give my permission to receive hair care services.

    I understand that the stylist does not diagnose illnesses or injuries, or prescribe medications.

    I have clearance from my physician to receive hair care services.

    I acknowledge that if I am allergic to one or more ingredients in the products used, I may experience allergic reactions.

    I acknowledge that this treatment is strictly an elective cosmetic procedure and no medical claims have been expressed or implied.

    I understand the importance of informing my stylist of all medical conditions and medications I am taking, and to let the stylist know about any changes to these. 

    I understand that it is my responsibility to inform my stylist of any discomfort I may feel during the session so he/she may adjust accordingly.

    I understand that I or the stylist may terminate the session at any time.

    I have been given a chance to ask questions about the session and my questions have been answered.

    I have read and accept Studio 512's cancellation policy.

    I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I give consent for all future treatments.

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