Client Hair Colour Consultation & Consent Form
Hello & Welcome,
Please note that while we choose to work with brands that are consciously moving towards lower tox colour formulations, no products are completely chemical free.It’s important to note that all hair colour contains active ingredients that may cause sensitivity or reaction. Reactions can also occur even if you’ve never experienced one before. For this reason, we take extra care and place your health, comfort, and wellbeing at the centre of every service. We kindly request this form is filled out prior to your hair appointment.
Personal Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact & Phone Number:
*
Hair History
Have you had your hair coloured previously?
*
Yes
No
If yes, please specify:
*
Permanent Hair Colour (example, grey coverage)
Demi / Semi-permanent
Lightening / Bleach
Toner / Gloss
Henna / Botanical colour
Date of last colour service: (approximately)
*
What products are you currently using?
Have you ever experienced a reaction to hair colour or hair products?
*
Yes
No
If yes, please explain:
Allergies & Sensitivities
Please tick any that apply and add details where relevant:
*
Skin sensitivities / dermatitis / eczema / psoriasis
Asthma or respiratory sensitivities
Chemical sensitivities
Fragrance sensitivities
Pregnancy or breastfeeding
Other allergies or sensitivities (please specify):
*
Scalp & Hair Condition
Do you currently experience any of the following?
*
Itchiness
Flaking / dandruff
Redness or irritation
Breakage
Excessive dryness
Hair thinning or shedding
None of the above
Additional notes about your scalp or hair health:
Lifestyle Considerations (Optional but Helpful)
These questions can assist in creating a more tailored and more conscious and supportive colour experience
Is this your first time opting for ammonia free hair colour & more natural products?
Yes
No
What prompted you to explore more conscious product choices?
Patch Test Acknowledgement
A patch test is recommended prior to my hair colour appointment especially if; I am a new client, I have a history of sensitivities or reactions or I have not coloured my hair in the last 6–12 months. Patch testing is an important step in supporting your safety and wellbeing. If you choose not to proceed with a recommended patch test, you acknowledge that you are doing so at your own discretion.
*
I acknowledge and understand the above.
Client Declaration & Consent
I confirm that the information provided above is true and complete to the best of my knowledge. I understand that results cannot be guaranteed and may vary depending on hair history, condition, and individual response to colour.I acknowledge that despite all due care, allergic reactions or sensitivities may occur and I accept responsibility for informing my stylist of any discomfort during or after the service
I acknowledge and understand the above
*
Date
*
-
Month
-
Day
Year
Date
Thank you,
Thank you for taking the time to fill out this form. I’ll be in touch soon and look forward to welcoming you. Warmly, Kalli - Blown Away Hair Spa
Continue
Continue
Should be Empty: