Chemical Release Form

Chemical Release Form
Name*

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Phone Number*

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Email*
example@example.com
Rooted Crown LLC, and Julie Ann Olsen recommend that all clients receiving any chemical services do a forty-eight-hour patch test prior to services.

I am aware and understand that receiving any chemical service can, in some individuals, cause an allergic reaction. I fully understand that this reaction can occur at any time, even if I have received this service on previous occasions. I further understand that it is Rooted Crown and Julie Ann Olsen's policy to perform a skin patch test forty-eight hours prior to all chemical services. I also understand that a negative skin patch test does not mean that a reaction will not still occur. I understand these risks, and if I have any concerns, I will seek medical advice prior to any chemical service.
Patch Test (I understand that by accepting a patch test, I must reschedule my current appointment for 48 hours after my patch test was received)*

Decline patch testI accept a patch test
Further, I grant Rooted Crown LLC, and Julie Ann Olsen permission to perform chemical services on my hair and not hold them responsible for any and all adverse health reactions from this service.

By signing this form, I assume all risk of injury and harm resulting from the treatment activity specified herein and I agree to release, defend, indemnify, and forever discharge Rooted Crown LLC, and Julie Ann Olsen 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.
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