Hair Service Client Consultation & Consent

Hair Service Client Consultation & Consent

Please complete this form to help us provide the best and safest service. All information is confidential.
General Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
What is your gender?
How did you hear about us?
Hair History
When was your last haircut?
Have you suffered from hair loss?
If yes, please explain:
Have you been diagnosed with alopecia?
If yes, please explain:
Do you take any medication?
If yes, please explain:
Do you have a sensitive scalp?
If yes, please explain:
Any other conditions:
Please list any medications you take regularly (including vitamins, herbal supplements, aspirin etc.):

CONSULTATION FORM ACKNOWLEDGMENT
Photo Release
I understand that: • Photos are inspiration, not exact guarantees • My hair texture, density, and previous services affect the result • My stylist will recommend adjustments if needed
I understand that results may vary depending on my hair texture, density, previous chemical services, and current hair condition. I have discussed my expectations with my stylist and agree to the haircut plan discussed.
Client Printed Name

First NameLast Name
Client signature
Consent form date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

General Information