• Head Spa & Mini Facial Consultation and Consent Form

    Please complete this form to help us provide a safe and personalized head spa and mini facial experience. Your information will remain confidential.

  • Client Information

    Please provide your personal and contact details.

  • HEALTH & SAFETY SCREENING

    Please answer the following:
  • Do you have any known allergies or sensitivities to skincare, scalp, or hair products?*
  • Are you currently using Retinol, Accutane, prescription acne medication, or other strong exfoliating products?*
  • Have you had any recent facial or scalp treatments within the past 2–4 weeks?*
  • Do you currently have any active irritation, rash, infection, open skin, cold sore, or sunburn on the face or scalp?*
  • Are you pregnant, breastfeeding, or currently taking any medication or undergoing treatment that may affect your skin or scalp?*

  • HAIR EXTENSION NOTICE

  • Do you currently have hair extensions installed?*

  • Note: Services performed on hair with extensions may be priced differently based on time, hair condition, and extension type.

  • PRIMARY CONCERN

  • Please check any scalp or skin concerns you have:*

  • CLIENT CONSENT

  • PHOTO AUTHORIZATION

  • Photos for treatment record only*
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  • Date Signed (Client)*
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