Chemical Release Form

Chemical Release Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
If the service is for a MINOR, please add their name here:

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
I hereby release Dapper & Dashin' Salon and Shop (the "Salon"), its stylists, colorists, and employees, from any responsibility and/or liability concerning the application, processing, and/or consequences of the permanent chemical procedure of my hair.
I hereby give my consent for the following services:
Leave blank for your stylist.
Hair types and colors have varying effects from chemical treatments and I have been made aware of my responsibilities for disclosing important information to my stylist(s) and the possible effects in case a treatment was made prior without their knowledge that may result to adverse chemical reactions.I have made my stylist aware of all of the treatments I have had in the past twelve to twenty-four months in order for them to assess the status of my hair and the process that they will make or recommend to me in order to achieve the results I desire.My stylist and I spoke and agreed on the price range of my desired service.In order for me to achieve my desired results, I will have to be clear with my stylist of my desires and wishes for my hair. My stylist may give recommendations which I may adhere to, for which my stylist thinks or believe would be best for me.I have disclosed any and all medications, skin sensitivities and allergies I have.I have disclosed any and all medical conditions I have including pregnancy and on-going medical treatments.I understand that multiple appointments/services may be needed to achieve my desired results.My hair stylists is not liable for stopping a service due to an adverse reaction on the skin or scalp that is unusual and can result in damage.
Include any other note or explanation to your stylist here.
Use this area to give more detail about any concerns you may have or to explain your allergies/medical condtions.
What was the price quote given?
For stylist use only after consultation. Input the exact amount or range discussed.
I received a price quote and my stylist reviewed any questions and concerns I had.I did not receive a price quote and my stylist did not review any questions and concerns I had.
At Dapper & Dashin', we strive to provide exceptional services tailored to meet your needs and desires. However, in the rare event that you are unhappy with your chemical service, we want to address your concerns promptly and effectively. Please read the following disclaimer carefully:
1. Client Satisfaction Priority: Our first and foremost priority is your satisfaction. If you are dissatisfied with any aspect of your chemical service, please inform us immediately so we can rectify the situation. Our priority is to get you rescheduled for any adjustments within 24-48 hours from when you notify us of the dissatified service.
2. Correction and Desired Result: We are committed to correcting any issues and ensuring you achieve your desired results. Our experienced stylists will work closely with you to understand your preferences and make the necessary adjustments to meet your expectations.
3. Partial Refund Consideration: If, despite our best efforts, we are unable to achieve your desired result, we may consider offering a partial refund as compensation for any inconvenience caused.
4. Severe Damage or Other Issues: In the unfortunate event of severe damage or any other significant issue arising from your chemical service, we will prioritize your well-being and satisfaction. In such cases, a full refund may be considered as appropriate reparation.
We encourage open communication throughout the process to ensure your concerns are addressed promptly and to your satisfaction. Please do not hesitate to reach out to us with any questions or concerns regarding your chemical service.
Your signature indicates your consent to proceed with the chemical service provided by Dapper & Dashin' Salon and Shop, with the understanding that we will make every effort to ensure your satisfaction.

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By signing this form, I assume all risk of injury and harm resulting from the chemical service specified herein and I agree to release, defend, indemnify, and forever discharge the Salon from all liabilities, claims, damages, costs, and expenses, or any action due to loss, damage, injury, or death that might incur resulting from the chemical treatment.
Yes, I am aware of all aspects of the chemical service my child(ren) are receiving and I give consent for Dapper and Dashin' to perform the service and I release Dapper and Dashin' from all liabilities.No, I do not give consent to my child(ren) to receive these services.
Please upload any updated inspiration pictures you and your stylist discussed here.

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- Name of Client (or consenting adult's name if the service is for a minor)*
- Signature of Client (or consenting adult's name if the service is for a minor)*
  
  Clear
- Date Signed*
  
  MonthDayYear
  Date
- Name of Stylist
- Signature of Stylist
  
  Clear
- Date Signed
  
  MonthDayYear
  Date
- Please detail any changes to the original inspiration picture in writing here.
- 1. What's the starting hair color level?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "What level is the client’s natural or existing color? Is there any previous color or lightening on the hair?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "Can you identify the natural base level and note if there’s any artificial pigment present?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: "Where are we starting from? What’s the current base level and condition of the hair?"
- 2. What's the desired end hair color level?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "What level and tone are you aiming to achieve? Is it lighter, darker, or staying at a similar depth?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "What’s the target level and undertone for this transformation?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: "What end result is the client requesting in terms of lightness and tone?"
- 3. What's your plan for the formula to achieve the target color?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "How do you plan to customize the formula for this specific client to reach the desired result?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "What developer strength and toning strategy will you use to achieve the target level?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: "What’s the formula breakdown, including any additives or adjustments for the client’s hair condition?"
- 4. What technique will I use to execute the look?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "Are you using foils, balayage, or teasy lights for this look?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "What placement and sectioning will best achieve the desired level of dimension?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: "Which technique will give you the contrast or softness the client is looking for?"
- 5. Are you enhancing or canceling a tone?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "Are you working to enhance warmth or neutralize it for a cooler finish?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "Will you be intensifying the existing tone or softening it to achieve the desired look?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: "Are you amplifying natural tones or canceling underlying pigments for balance?"
- 6. What are you toning with?
  𝐎𝐏𝐓𝐈𝐎𝐍 𝟏: "Which toner or gloss are you selecting to refine the final color? Is it permanent or demi-permanent?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟐: "What specific toner will give you the desired result, and are you using it to cool, neutralize, or warm the tone?" 𝐎𝐏𝐓𝐈𝐎𝐍 𝟑: ""What product line and shade will you be using to complete the toning process?"
- OTHER NOTES FROM YOUR STYLIST
  Use this area to document anything that was discussed in-person like pricing, desired results and level, etc. that should be tracked.
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