Hair Colouring Services - Client Consent & Release Form
Salon Name:
Client Name:
Date:
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Month
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Day
Year
Date
Stylist:
1. CLIENT HISTORY
Have you previously had any of the following?
- Allergic reaction to hair colour or chemicals?
Yes
No
- Sensitive scalp or skin conditions?
Yes
No
- Henna, metallic dyes, or box dye on your hair?
Yes
No
- Chemical straightening, perming, or keratin treatment?
Yes
No
- Currently pregnant or breastfeeding?
Yes
No
- Any medications or medical conditions that may affect your hair or skin?
Yes
No
If YES to any of the above, please provide details:
2. PATCH TESTING
I understand that:
- A patch test is recommended before any colour service, especially if I have not previously had
- Allergic reactions can occur even if I have had colour services before.
- Declining a patch test means I accept full responsibility for any adverse reaction.
Patch Test Completed: Yes - Date:
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Month
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Day
Year
Date
Declined by Client
3. SERVICE ACKNOWLEDGEMENT
I acknowledge and understand the following:
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Hair colouring is a chemical process and results cannot be 100% guaranteed.
Final results may vary due to previous colour history, hair condition, home care, water quality, medications, or underlying pigments.
Multiple appointments may be required to achieve my desired result.
Lightening services (bleaching, balayage, foiling, colour correction) can cause dryness or changes to hair texture.
Fashion colours and major colour changes require ongoing maintenance.
The salon will recommend appropriate aftercare products to maintain the health and longevity of my colour.
4. RISK DISCLOSURE
I understand that colouring services may involve risks including, but not limited to:
Allergic reactions
Scalp irritation or sensitivity
Hair breakage or damage
Unexpected or uneven colour results
Colour fading or tonal changes over time
5. RELEASE OF LIABILITY
By signing this form, I confirm that:
I have fully disclosed my hair history to the best of my knowledge.
I give permission for the stylist to perform the agreed colouring service.
I accept the inherent risks involved with chemical hair services.
I release the salon, its owners, and employees from liability for any adverse reactions, damage, or dissatisfaction resulting from the colouring process, provided services are carried out with reasonable care and professional standards.
I understand that no refunds are given for change of mind.
6. AFTERCARE RESPONSIBILITY
I agree to follow the aftercare instructions provided by my stylist and understand that failure to do so may affect the longevity and condition of my colour.
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CLIENT DECLARATION
I have read and understood this form in full. I consent to proceed with the colouring service at my
own risk.
Client Signature:
Print Name:
Date:
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Month
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Day
Year
Date
Stylist Signature:
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