@Decker.INC Lounge
New Client Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Birthday 🎂: (we would love to celebrate)
-
Month
-
Day
Year
Date
How did you hear about Decker.INC Lounge
Instagram
Facebook
Reviews
Referral
Other
Any allergies your provider needs to know about:
EMERGENCY CONTACT NAME:
First Name
Last Name
EMERGENCY CONTACT PHONE NUMBER:
Please enter a valid phone number.
Format: (000) 000-0000.
If you are a referral, please list who referred you 🫶🏻
What service would you like to get done today:
Chemical Hair Service
Hair treatment
Washing
Brow’s
Cut-Style
Lashes
Spray Tanning
Waxing
Aesthetician services
Extensions
Acne treatment
Permanent jewelry
Special occasion service
Other
If you do not see your service listed: There will be a Consent/Waiver form provided at the salon. Please select your service down below
Permanent Jewelry
Spray Tan
Hyaluronic Acid Pen
Special Occasion, Hair And Makeup
Photography
Bridal Services
Are we allow to post our work we serviced on you:
Yes!!! I love the camera and content
I am not a fan of the camera
Please list daily medication:
Are you okay with dogs? Decker.INC Lounge has pups that come to hangout in the salon. They can snuggle at home if answer is no! Please be honest
Love puppies bring them
If you do not mind, please leave them home
What makes you very comfortable in a salon:
Next are Consent & Questions given by your provider
If you will be reserving multiple appointments with us for different services, today or in the future. Please fill out all questions :
Hair Appointments Only:
Please answer following questions and upload your photos:
Please briefly explain your hair history:
Have you ever used box hair dye at home? If Yes, when
Upload photos of your hair now: outside and inside.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your inspiration photos of your service today:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Is there anything that concerns you about your hair:
Do you agree to follow the aftercare instructions provided to ensure the best results and minimize potential complications?
Yes
No
Have you had any allergic reactions to hair dyes or chemicals in the past?
Yes
No
Have you had any recent scalp conditions or irritations? If yes please explain:
Do you understand the potential risks of chemical treatments, such as hair damage or scalp irritation?
Yes
No
Aesthetician Service’s Only:
Please answer following questions and upload your photos:
Please briefly explain your daily skin routine+ ingredients, if possible:
Please briefly explain your skin history:
How would you best describe your skin (daily)
Dry
Textured
Oily
Dry + Oily
Normal
Sensitive
What would be your ideal dream outcome look like?
Is there any particular ingredients or products that makes your skin sensitive?
Have you recently had any cosmetic procedures (e.g., Botox, fillers, chemical peels)?
Are you currently using any prescription skincare medications (e.g., retinoids, Accutane)?
Upload a beautiful natural photo, for provider to examine your skin:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you agree to follow the aftercare instructions provided to ensure the best results and minimize potential complications?
Yes
No
Do you understand the potential risks of aesthetic treatments, such as redness, irritation, or breakouts?
Yes
No
Do you agree to inform your aesthetician of any discomfort or concerns during the service?
Yes
No
Lash/Brow Service’s Only:
Please answer following questions and upload your photos:
Do you have any known allergies to adhesives, dyes, or other cosmetic products?
Are you currently using any medications or undergoing treatments that may affect your skin or hair?
Have you experienced any reactions to lash or brow treatments in the past?
Yes
No
Do you wear contact lenses, and will you be able to remove them before the service?
Yes
No
Do you understand the risks associated with lash and brow services, such as irritation, allergic reactions, or damage to natural lashes/brows?
Yes
No
Do you agree to follow the aftercare instructions provided to ensure the best results and minimize potential complications?
Yes
No
The Consent/Waiver Signature
Please read and sign the agreement
Read the following and check all boxes if you agree:
I have communicated with my Service Provider on the history of my hair/lashes/brows and or skin
I understand all goals can not be hit immediately and a couple of appointments might be necessary
I release My service Provider from any liability for injuries, burns, reactions that may occur as from the treatment. I agree to release Provider from all claims, damages and legal actions to all Decker.INC Lounge services and procedures
By signing this consent I confirm I am 18 years or older (if not please have an adult guardian sign and send me a message for consent) I confirm I have fully read all details and understand the agreement. I accept to receive my service/services with Provider at Decker.INC Lounge
I
First Name
*
Last Name
*
by signing this wavier I agree I have read and agreed to the following.
Signature
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