• House of Peruke

    House of Peruke

    Waiver Form
  • HOUSE OF PERUKE

  • HAIR REPLACEMENT AND RESTORATION SERVICE

  • NON SURGICAL HAIR REPLACMENT CONSENT FORM

  • I understand that I am consenting to have the hair on my head partially or completely shaved in order to wear nonsurgical hair replacement (i.e., toupees, toppers, extensions, etc I am aware that shaving my hair may result in a temporary change in my appearance and may require regular maintenance to keep the hair replacement system looking natural. By providing this consent, I acknowledge that I understand the potential risks and agree to proceed with the shaving of my hair to wear nonsurgical hair replacement.

    I acknowledge that the service is final after the application. Any changes to the style after application will be

    I acknowledge that hair replacement (i.e., toupees, toppers, extensions, etc is very sensitive and different from intact human hair. I have been informed of the daily maintenance procedures and will follow them to keep my extensions in the best condition possible. I am fully aware and responsible that if I brush my hair hard, puncture a hole in the system, or pull the hair replacement, it can be ripped from the hair root or scalp itself.

    Iacknowledge that I have inspected and approved the installation of the hair system in my hair and scalp. In the event that I decide not to keep the hair system, | am fully responsible for the total payment of services rendered.I

    also understand the explanations of the entire procedure, and I am aware that with proper care on my part, the system should remain for 3-6 months. I understand that if an allergic reaction occurs, I will not hold my technician or salon at fault. The charge for the removal of hair extensions is not included in the original fee.

    I have read this waiver form in its entirety, and I voluntarily accept the terms of the release by affixing my signature

    below and warrant that I fully understand its contents.

  • CLIENTS SIGNATURE

  • Powered by Jotform SignClear
  •  
  • Should be Empty: